| Valley Sports And Spine Clinic | |
|
120 Professional Park Dr Se Ste 7 Blacksburg VA 24060-6739 | |
| (540) 443-3832 | |
| (540) 443-9362 |
| Full Name | Valley Sports And Spine Clinic |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 120 Professional Park Dr Se Ste 7, Blacksburg, Virginia |
| Authorized Official Name and Position | Ethan B Colliver (PRESIDENT) |
| Authorized Official Contact | 5405534587 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valley Sports And Spine Clinic 120 Professional Park Dr Se Ste 7 Blacksburg VA 24060-6739 Ph: (540) 443-3832 | Valley Sports And Spine Clinic 120 Professional Park Dr Se Ste 7 Blacksburg VA 24060-6739 Ph: (540) 443-3832 |
| NPI Number | 1447545751 |
|---|---|
| Provider Enumeration Date | 06/15/2011 |
| Last Update Date | 12/16/2022 |
| Medicare PECOS PAC ID | 2264603026 |
|---|---|
| Medicare Enrollment ID | O20110927000817 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447545751 | NPI | - | NPPES |
| Provider Name | Ethan Colliver |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1184803330 PECOS PAC ID: 4587736053 Enrollment ID: I20091006000220 |
| Provider Name | William D Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386811073 PECOS PAC ID: 9335381904 Enrollment ID: I20130809000667 |
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