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General NPI Number Information
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NPI Number | 1568855427
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Entity Type | Organization
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Legal Business Name | SOUTHWEST VIRGINIA NEPHROLOGY MEDICINE, PC
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 06/13/2020
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Provider Practice Location Address
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Address Line | 4806 PLEASANT HILL DR SUITE 102
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City | ROANOKE
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State | VA
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Zip | 24018-3441
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Country | US
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Telephone | 540-904-5366
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Fax | 540-904-5598
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Provider Business Mailing Address
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Address Line | 4806 PLEASANT HILL DR STE 102
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City | ROANOKE
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State | VA
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Zip | 24018-3440
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Country | US
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Telephone | 540-904-5366
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Fax | 540-904-5598
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | FLETCHER G MATTHEWS
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Credential | MD
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Telephone | 540-904-5366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 101226961
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License Number State | VA
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