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General NPI Number Information
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NPI Number | 1467117267
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Entity Type | Organization
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Legal Business Name | JRG OF VIRGINIA LLC
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Dates
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Enumeration Date | 11/05/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 1315 2ND ST SW STE 103
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City | ROANOKE
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State | VA
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Zip | 24016-4935
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Country | US
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Telephone | 540-900-5633
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Fax | 540-730-7780
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Provider Business Mailing Address
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Address Line | 1315 2ND ST SW STE 103
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City | ROANOKE
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State | VA
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Zip | 24016-4935
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Country | US
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Telephone | 540-900-5633
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Fax | 540-730-7780
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS F CAMPAGNOLI
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Credential |
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Telephone | 540-900-5633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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