NPIMap

Organization Active NPI

Roanoke Oral Surgery, Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Roanoke, VA
National Provider Identifier
1104007384
Registry record updated Nov 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
0401004673 Issued in VA
Legal business name
ROANOKE ORAL SURGERY, INC.
Practice address
6027 Peters Creek Rd
Roanoke, VA 24019-4029
Phone
(540) 362-5900
Fax
(540) 366-5131
NPI assigned
Nov 16, 2007
Last updated
Nov 16, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. James T. McClung Jr., DDSNPI 1962472878
Title
President
Phone
(540) 362-5900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 0401004673 VA Primary

Addresses

Primary practice location

6027 Peters Creek Rd
Roanoke, VA 24019-4029

Mailing address

PO Box 7889
Roanoke, VA 24019-0889
Phone (540) 362-5900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041109000755 VA Part B Supplier - Clinic/Group Practice 1456314681 Receives reassigned benefits from 4 practitioners
Practice locations: Roanoke, VA

National Provider Directory

National Provider Directory

Locations

3229 Brandon Ave SW
Roanoke, VA 24018
Phone (540) 362-5900

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1104007384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7889",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240190889",
            "telephone_number": "540-362-5900",
            "fax_number": "540-366-5131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6027 PETERS CREEK RD",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240194029",
            "telephone_number": "540-362-5900",
            "fax_number": "540-366-5131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE ORAL SURGERY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2007-11-16",
        "status": "A",
        "authorized_official_last_name": "MCCLUNG",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "540-362-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VA",
            "license": "0401004673",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.