GILL MEMORIAL ENT CLINIC, PC (NPI# 1497957419) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497957419 |
| Entity Type | Organization |
| Organization Name | GILL MEMORIAL ENT CLINIC, PC |
| Practice Address |
707 S Jefferson St Fl 5 Roanoke VA 24016-5100 |
| Practice Telephone | 5403442071 |
| Practice Fax Number | 5409828490 |
| Mailing Telephone | 5403442071 |
| Mailing Fax Number | 5409828490 |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2007-07-30 |
| Authorized Official Name | DR. MARK R HANABURY JR. (OWNER) |
| Authorized Official Telephone | 5403442071 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 0101031266 | VA | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | AETNA | 4243474 | 01 |
| VA | RAILROAD MEDICARE | P00143294 | 01 |
| VA | ANTHEM | 143175 | 01 |
| VA | SOUTHERN HEALTH | 243144 | 01 |
| Street Address |
707 S JEFFERSON ST FL 5 |
| City | ROANOKE |
| State | VA |
| Zip Code | 24016-5100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134758329 | Davis Andrew Sugar | Student in an Organized Health Care Education/Training Program | 1 Riverside Circle, Suite 401, Roanoke, Va, 24016, Suite 401, Roanoke, VA 24016 | 2020-04-08 |
| 1356810659 | Susanne Tribble | Social Worker | 202 Wells Ave Nw, Roanoke, VA 24016 | 2018-11-15 |
| 1801305818 | Rena Lee Daye | Driver | 10 12th St. Sw, Roanoke, VA 24016 | 2017-09-21 |
| 1053841965 | Christin Elledge Clark | Nurse Practitioner | 1234 Franklin Road, Roanoke, VA 24016 | 2017-06-13 |
| 1235685884 | Helen Franck | Physical Therapist | 650 North Jefferson Street, Roanoke, VA 24016 | 2016-09-01 |
| 1457710238 | Frances Marie Gaeta | Social Worker | 360 Campbell Ave, Roanoke, VA 24016 | 2016-02-22 |
| 1982073292 | Sophie Mench Tranmer | Physical Therapist | 1421 Third St. Sw, Roanoke, VA 24016 | 2015-09-16 |
| 1982008181 | National Counseling Group, Inc | Psychiatry & Neurology | 20 Walnut Avenue, Roanoke, VA 24016 | 2014-10-17 |
| 1366858342 | National Counseling Group, Inc | Psychiatry & Neurology | 16 Walnut Avenue, Roanoke, VA 24016 | 2014-07-10 |
| 1427320878 | Kristen L. Jagger | Physical Medicine & Rehabilitation | 1015 First Street Sw Suite 2, Roanoke, VA 24016 | 2012-02-01 |
| Find all providers in zip 24016 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427682319 | Diana Alejandra Rojas | Specialist | 509 E Byron Nelson Blvd Ste C, Roanoke, TX 76262-6183 | 2020-02-28 |
| 1013473081 | Whitney Matheson | Specialist | 6803 Dallas Rd, Roanoke, VA 24019-2310 | 2019-02-14 |
| 1033681036 | Stacey Caputo | Specialist | 2149 Electric Rd Ste 3, Roanoke, VA 24018-1975 | 2019-01-02 |
| 1326468646 | Kimberly Covell Mcinnis | Specialist | 5649 Meadowcrest St, Roanoke, VA 24019-4833 | 2014-04-25 |
| 1407192735 | Virginia Interventional Pain & Spine Center, Inc. | Specialist | 3800 Electric Rd Ste 307, Roanoke, VA 24018-4568 | 2012-12-13 |
| 1699952424 | Chrissy Lee Mcconnaughy | Specialist | 1809 Sheffield Rd Sw, Roanoke, VA 24015-3021 | 2008-01-23 |
| 1639390644 | Junius Ellett Crowgey | Specialist | 3814 Belle Aire Cir Sw, Roanoke, VA 24018-1251 | 2007-05-01 |
| 1558586776 | Wayne Starr Miller | Specialist | 7735 E Manitou Trl-92, Roanoke, IN 46783-9203 | 2007-04-14 |
| 1508927021 | Darrell Franklin Powledge | Specialist | 512 Mcdowell Ave., Ne, Suite B, Roanoke, VA 24016 | 2006-12-12 |
| 1609958776 | Southwest Virginia Center for Cosmetic Plastic & Recon Surgery | Specialist | 2965 Colonnade Drive, Suite 140, Roanoke, VA 24018-3541 | 2006-10-19 |
| Find all providers in ROANOKE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.