Basic Information
| Provider Information | |||||||||
| NPI: | 1316030711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUALITY OF LIFE MEDICAL SPECIALTIES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6149 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240193813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404007765 | ||||||||
| FaxNumber: | 5404007555 | ||||||||
| Practice Location | |||||||||
| Address1: | 6149 AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240193813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409922225 | ||||||||
| FaxNumber: | 5403447154 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2006 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | VERNA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5404007765 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.