=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831527126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADA SPECIALTIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2013
-----------------------------------------------------
Last Update Date | 10/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2944 ORANGE AVE NE
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24012-6339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-982-3526
-----------------------------------------------------
Fax | 540-985-9166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2944 ORANGE AVE NE
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24012-6339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-982-3526
-----------------------------------------------------
Fax | 540-985-9166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | MRS. CHRISTINE J MARTIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-892-0449
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------