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General NPI Number Information
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NPI Number | 1790951267
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Entity Type | Organization
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Legal Business Name | ON-SITE SPORTS MEDICINE SERVICES, INC.
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 05/05/2008
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Provider Practice Location Address
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Address Line | 440 HIGHLAND AVE SW
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City | ROANOKE
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State | VA
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Zip | 24016-4214
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Country | US
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Telephone | 180-047-2064
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21467
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City | ROANOKE
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State | VA
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Zip | 24018-0555
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Country | US
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Telephone | 180-047-2064
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MRS. TALENA COX WILLIAMS
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Credential | ATC/L; PA-C
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Telephone | 800-472-0646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | VA
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