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General NPI Number Information
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NPI Number | 1750391611
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Entity Type | Organization
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Legal Business Name | UNIVERSITY GERIATRICS LLC
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 2265 KRAFT DRIVE
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City | BLACKSBURG
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State | VA
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Zip | 24060
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Country | US
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Telephone | 540-552-2500
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Fax | 540-552-3100
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Provider Business Mailing Address
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Address Line | PO BOX 8310
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City | ROANOKE
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State | VA
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Zip | 24014-0310
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Country | US
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Telephone | 540-345-3556
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Fax | 540-342-2193
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD T WILLIAMS
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Credential | M.D.
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Telephone | 540-345-3556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101048138
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License Number State | VA
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