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NPI Code Detail

MEDICARE: ROAM WEST VIRGINIA PLLC

MEDICARE: ROAM WEST VIRGINIA PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1558207233
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROAM WEST VIRGINIA PLLC
Provider Business Mailing Address
First Line : 16352 BRIGADOON TRL
Second Line :
City : GULF SHORES
State : AL
Zip : 36542-8249
Country : US
Telephone Number : 719-565-8633
Fax Number :
Provider Business Practice Location Address
First Line : 650 WASHINGTON AVE
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-1042
Country : US
Telephone Number : 719-565-8633
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MS. DEBORAH ALLEN
Credential : PAC
Telephone Number : 719-565-8633
Provider Enumeration Date : 04/27/2026
Last Update Date : 04/27/2026

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Directions to “ROAM WEST VIRGINIA PLLC ” Practice Location

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