MEDICARE: SAMERAWIT K ADAGISH

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	343900000X	Non-emergency Medical Transport (VAN)	11111571	VA

General Provider Information

NPI Number	:	1760084370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMERAWIT K ADAGISH

Provider Business Mailing Address
First Line	:	3451 BRANDON AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-1513
Country	:	US
Telephone Number	:	540-815-5860
Fax Number	:	540-815-5860

Provider Business Practice Location Address
First Line	:	3451 BRANDON AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-1513
Country	:	US
Telephone Number	:	866-294-1982
Fax Number	:	866-294-1982

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	01/01/2026

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Directions to “ SAMERAWIT K ADAGISH ” Practice Location

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