=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821021858
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROANOKE ORTHOPAEDIC CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 12/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4064 POSTAL DR
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-6438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-776-0200
-----------------------------------------------------
Fax | 540-777-5850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 21369
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24018-0546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-776-0200
-----------------------------------------------------
Fax | 540-777-5850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/ORTHOPAEDIC SURGEON
-----------------------------------------------------
Name | DR. HUGH J HAGAN III
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 540-776-0200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------