| Renew Psychiatry Services | |
|
177 Electric Rd Salem VA 24153 | |
| (678) 900-0308 | |
| (540) 204-4097 |
| Full Name | Renew Psychiatry Services |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 177 Electric Rd, Salem, Virginia |
| Authorized Official Name and Position | Michie Armell Bolden (OWNER) |
| Authorized Official Contact | 6789000308 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renew Psychiatry Services 5715 Glen Haven Dr Roanoke VA 24019-4064 Ph: (678) 900-0308 | Renew Psychiatry Services 177 Electric Rd Salem VA 24153 Ph: (678) 900-0308 |
| NPI Number | 1134607898 |
|---|---|
| Provider Enumeration Date | 08/03/2018 |
| Last Update Date | 06/11/2019 |
| Medicare PECOS PAC ID | 2769715879 |
|---|---|
| Medicare Enrollment ID | O20190605000257 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134607898 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Michie Armell Bolden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659815736 PECOS PAC ID: 8224313762 Enrollment ID: I20170323000733 |
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