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NPI Code Detail

MEDICARE: BLUE RIDGE PHYSICAL MEDICINE

MEDICARE: BLUE RIDGE PHYSICAL MEDICINE
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
1261QP3300XPain Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710173679
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE RIDGE PHYSICAL MEDICINE
Provider Business Mailing Address
First Line : 4582 FRANKLIN RD SW
Second Line :
City : ROANOKE
State : VA
Zip : 24014-5144
Country : US
Telephone Number : 540-772-8052
Fax Number : 540-772-4508
Provider Business Practice Location Address
First Line : 4582 FRANKLIN RD SW
Second Line :
City : ROANOKE
State : VA
Zip : 24014-5144
Country : US
Telephone Number : 540-772-8052
Fax Number : 540-772-4508
Authorized Official
Title or Position : OWNER
Name : DR. REBECCA W TANNER
Credential :
Telephone Number : 540-772-8052
Provider Enumeration Date : 09/24/2007
Last Update Date : 09/24/2007

Similar Medicare Providers

1548367667 — DR. REBECCA WEBB TANNER
Practice Location Address:
4582 FRANKLIN RD SW
ROANOKE, VA
24014-5144
Practice Phone: 540-772-8052
Practice Fax: 540-772-4508
1881743367 — DR. RICHARD D SMITH II DDS
Practice Location Address:
4572 FRANKLIN RD SW
ROANOKE, VA
24014-5144
Practice Phone: 540-769-5020
Practice Fax: 540-769-5021
1760509012 — MS. KAREN L. HUTCHISON DMD
Practice Location Address:
4572 FRANKLIN RD SW
ROANOKE, VA
24014-5144
Practice Phone: 540-769-5020
Practice Fax:
1861519027 — DR. MICHELE M. MILLS
Practice Location Address:
4572 FRANKLIN RD SW
ROANOKE, VA
24014-5144
Practice Phone: 540-769-5020
Practice Fax:
1285955260 — RICHARD D SMITH II DDS PC
Practice Location Address:
4572 FRANKLIN RD SW
ROANOKE, VA
24014-5144
Practice Phone: 540-769-5020
Practice Fax: 540-769-5021
1992259998 — DR. BRADLEY RICHARD OLIVER DDS
Practice Location Address:
4572 FRANKLIN RD SW
ROANOKE, VA
24014-5144
Practice Phone: 540-769-5020
Practice Fax: 540-769-5021

Directions to “BLUE RIDGE PHYSICAL MEDICINE ” Practice Location

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