Basic Information
| Provider Information | |||||||||
| NPI: | 1386837250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROANOKE VALLEY SPEECH AND HEARING CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2030 COLONIAL AVE SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240153204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403430165 | ||||||||
| FaxNumber: | 5403454664 | ||||||||
| Practice Location | |||||||||
| Address1: | 2030 COLONIAL AVE SW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240153204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403430165 | ||||||||
| FaxNumber: | 5403454664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | BROOKS | ||||||||
| AuthorizedOfficialFirstName: | J. | ||||||||
| AuthorizedOfficialMiddleName: | ANDREE' | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5403430165 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 2201000601 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 247018 | 01 | VA | ANTHEM | OTHER | 7602827 | 01 | VA | AETNA | OTHER |