| Performance Medicine Of Southwest Virginia, Llc | |
|
25 W Calhoun St Salem VA 24153-3836 | |
| (540) 772-1890 | |
| (540) 772-1893 |
| Full Name | Performance Medicine Of Southwest Virginia, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 25 W Calhoun St, Salem, Virginia |
| Authorized Official Name and Position | Delmas J Bolin (PRESIDENT) |
| Authorized Official Contact | 5407721890 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Performance Medicine Of Southwest Virginia, Llc 25 W Calhoun St Salem VA 24153-3836 Ph: (540) 772-1890 | Performance Medicine Of Southwest Virginia, Llc 25 W Calhoun St Salem VA 24153-3836 Ph: (540) 772-1890 |
| NPI Number | 1679905467 |
|---|---|
| Provider Enumeration Date | 08/02/2013 |
| Last Update Date | 05/23/2024 |
| Medicare PECOS PAC ID | 6507000486 |
|---|---|
| Medicare Enrollment ID | O20130916000007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679905467 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 2081S0010X | Physical Medicine & Rehabilitation - Sports Medicine | (* (Not Available)) | Secondary |
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