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General NPI Number Information
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NPI Number | 1508963794
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Entity Type | Organization
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Legal Business Name | ROANOKE FAMILY MEDICINE INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 3990 COLONIAL AVE
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City | ROANOKE
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State | VA
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Zip | 24018-3740
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Country | US
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Telephone | 540-772-1006
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Fax | 540-772-1086
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Provider Business Mailing Address
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Address Line | PO BOX 4127
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City | ROANOKE
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State | VA
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Zip | 24015-0127
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Country | US
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Telephone | 540-981-9394
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Fax | 540-344-7154
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDWARD L WILKES
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Credential |
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Telephone | 540-721-1006
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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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