Provider Demographics
NPI:1255337697
Name:ROANOKE COUNTY BOARD OF SUPERVISORS
Entity type:Organization
Organization Name:ROANOKE COUNTY BOARD OF SUPERVISORS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIVISION CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-777-8701
Mailing Address - Street 1:PO BOX 20862
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0087
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ROANOKE COUNTY PUBLIC SAFETY CENTER
Practice Address - Street 2:5925 COVE ROAD
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019
Practice Address - Country:US
Practice Address - Phone:540-777-8701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4423416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009011404Medicaid
590014822OtherRAILROAD MEDICARE
VA590000208Medicare PIN