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General NPI Number Information
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NPI Number | 1649968223
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Entity Type | Organization
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Legal Business Name | BRAIN INJURY SERVICES OF SWVA
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 3904 FRANKLIN RD SW STE B
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City | ROANOKE
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State | VA
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Zip | 24014-3039
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Country | US
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Telephone | 540-344-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 3904 FRANKLIN RD SW STE B
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City | ROANOKE
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State | VA
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Zip | 24014-3039
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Country | US
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Telephone | 540-344-1200
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JODI JUDGE
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Credential |
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Telephone | 540-344-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 2084P0301X
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Taxonomy Name | Brain Injury Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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