NPIMap

Organization Active NPI

Roanoke Valley Health Services Inc

Doing business as Wildwood Medical Clinic

  • Family Medicine Physician
  • Henrico, NC
National Provider Identifier
1881704997
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ROANOKE VALLEY HEALTH SERVICES INC
Doing business as
Wildwood Medical Clinic
Practice address
2053 River Road
Henrico, NC 27842-0392
Phone
(252) 537-9400
Fax
(252) 537-1221
NPI assigned
Aug 30, 2006
Last updated
Mar 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Authorized official

Name
Russ Gardner
Title
Clinics Manager
Phone
(252) 535-1398

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2053 River Road
Henrico, NC 27842-0392

Mailing address

PO Box 392
2053 River Rd
Henrico, NC 27842-0392
Phone (252) 537-9400

Other identifiers 1

IdentifierTypeStateIssuer
348933AMedicaidNC

Other names 1

  • WILDWOOD MEDICAL CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050119001033 NC Part B Supplier - Clinic/Group Practice 4587573159 Receives reassigned benefits from 9 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, NC; Knightdale, NC; Roanoke Rapids, NC

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1881704997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 392",
            "address_2": "2053 RIVER RD",
            "city": "HENRICO",
            "state": "NC",
            "postal_code": "278420392",
            "telephone_number": "252-537-9400",
            "fax_number": "252-537-1221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2053 RIVER ROAD",
            "city": "HENRICO",
            "state": "NC",
            "postal_code": "278420392",
            "telephone_number": "252-537-9400",
            "fax_number": "252-537-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROANOKE VALLEY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "RUSS",
        "authorized_official_title_or_position": "CLINICS MANAGER",
        "authorized_official_telephone_number": "252-535-1398"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "348933A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILDWOOD MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henrico, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; 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.