| Joint Regeneration Group Of Virginia | |
|
1315 2nd St Sw Ste 103 Roanoke VA 24016-4935 | |
| (540) 900-5633 | |
| (540) 730-7780 |
| Full Name | Joint Regeneration Group Of Virginia |
|---|---|
| Speciality | Internal Medicine |
| Location | 1315 2nd St Sw Ste 103, Roanoke, Virginia |
| Authorized Official Name and Position | Nicholas F Campagnoli (OWNER) |
| Authorized Official Contact | 5409005633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Joint Regeneration Group Of Virginia 1315 2nd St Sw Ste 103 Roanoke VA 24016-4935 Ph: (540) 900-5633 | Joint Regeneration Group Of Virginia 1315 2nd St Sw Ste 103 Roanoke VA 24016-4935 Ph: (540) 900-5633 |
| NPI Number | 1467117267 |
|---|---|
| Provider Enumeration Date | 11/05/2021 |
| Last Update Date | 11/09/2021 |
| Medicare PECOS PAC ID | 7416348545 |
|---|---|
| Medicare Enrollment ID | O20211229000442 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467117267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Matthew B Fulton |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1609814441 PECOS PAC ID: 0244235547 Enrollment ID: I20060920000128 |
| Provider Name | Joseph Ernest Grisetti |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629505862 PECOS PAC ID: 8325312309 Enrollment ID: I20170914004220 |
| Provider Name | Vera Jane Short |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104325778 PECOS PAC ID: 5294085817 Enrollment ID: I20180831001579 |
| Provider Name | Heather E Wise |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306309570 PECOS PAC ID: 2062824303 Enrollment ID: I20201210002120 |
| Provider Name | Stacey Rorie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992162796 PECOS PAC ID: 3173807948 Enrollment ID: I20220606002192 |
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