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General NPI Number Information
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NPI Number | 1922244938
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Entity Type | Organization
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Legal Business Name | BLACKSBURG INTERNAL MEDICINE AND CARDIOLOGY
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Dates
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Enumeration Date | 12/22/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 840 HOSPITAL DR
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City | BLACKSBURG
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State | VA
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Zip | 24060-7023
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Country | US
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Telephone | 540-953-0530
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Fax | 540-953-0510
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Provider Business Mailing Address
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Address Line | PO BOX 928
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City | BLACKSBURG
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State | VA
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Zip | 24063-0928
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Country | US
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Telephone | 540-953-0530
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Fax | 540-953-0510
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Authorized Official
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Title or Position | PRESIDENT
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Name | J EDWIN WILDER
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Credential | MD
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Telephone | 540-953-0530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101047913
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License Number State | VA
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