MEDICARE: VALLEY GEROPSYCHIATRY LLC

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
1	2084P0805X	Geriatric Psychiatry Physician

General Provider Information

NPI Number	:	1720574569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY GEROPSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	2123B CRYSTAL SPRING AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-2413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2123B CRYSTAL SPRING AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-2413
Country	:	US
Telephone Number	:	540-266-3136
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID TRINKLE
Credential	:	MD
Telephone Number	:	540-266-1336

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	08/19/2022

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