BRADLEY FREE CLINIC OF ROANOKE VALLEY (NPI# 1902157712) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902157712 |
| Entity Type | Organization |
| Organization Name | BRADLEY FREE CLINIC OF ROANOKE VALLEY |
| Other Organization Name | BRADLEY FREE CLINIC |
| Practice Address |
1240 3rd St Sw Roanoke VA 24016-4612 |
| Practice Telephone | 5403445156 |
| Practice Fax Number | 5407770726 |
| Mailing Telephone | 5403445156 |
| Mailing Fax Number | 5407770726 |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2016-10-04 |
| Authorized Official Name | JAMES BLACK (PHARMACIST IN CHARGE) |
| Authorized Official Telephone | 5403445156 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | 0201002648 | VA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2164384 | 01 |
| Other Name | Type Code |
|---|---|
| BRADLEY FREE CLINIC | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Bradley Free Clinic of Roanoke Valley Inc. | 1240 Third Street Sw, Roanoke, Virginia 24016 |
| Street Address |
1240 3RD ST SW |
| City | ROANOKE |
| State | VA |
| Zip Code | 24016-4612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154303600 | Jennifer B Chen | Internal Medicine | 1240 3rd St Sw, Bradley Free Clinic, Roanoke, VA 24016-4612 | 2005-11-18 |
| 1033726104 | Doris Amo-mensah | Pharmacist | 1240 3rd St Sw, Roanoke, VA 24016-4612 | 2020-09-23 |
| 1497295422 | Geraldine Vallesteros | Pediatrics | 1240 3rd St Sw, Roanoke, VA 24016-4612 | 2017-02-23 |
| 1376878850 | Barbara Carol Moore | Obstetrics & Gynecology | 1240 3rd St Sw, Roanoke, VA 24016-4612 | 2009-10-16 |
| 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 | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619253846 | Chs Inc | Pharmacy | 3 Riverside Circle Ground Floor, Roanoke, VA 24016 | 2011-11-02 |
| 1134260516 | Shawsville Pharmacy Inc | Pharmacy | 2201 Crystal Spring Ave Sw, Roanoke, VA 24014-2416 | 2007-02-09 |
| 1992802730 | Sanco Drug Inc | Pharmacy | 1270 Riverland Rd Se, Roanoke, VA 24014-3508 | 2006-09-20 |
| 1497867303 | Bear Creek Drug Inc | Pharmacy | 3328 Brambleton Ave, Roanoke, VA 24018-6523 | 2006-08-31 |
| 1124130034 | Mountain Rx LLC | Pharmacy | 3324 Williamson Rd Nw, Roanoke, VA 24012-4058 | 2006-08-31 |
| 1194730705 | Lineville Clinic Pharmacy LLC | Pharmacy | 3705 Highway 431 Ste B, Roanoke, AL 36274-1430 | 2006-07-30 |
| 1447275169 | Kroger Limited Partnership I | Pharmacy | 4488 Electric Rd, Roanoke, VA 24018-0722 | 2006-07-13 |
| 1356375125 | Kroger Limited Partnership I | Pharmacy | 5050 Rutgers St Nw, Roanoke, VA 24012-1326 | 2006-07-10 |
| 1063446847 | Kroger Limited Partnership I | Pharmacy | 614 Brandon Ave Sw, Roanoke, VA 24015-3212 | 2006-07-10 |
| 1972537751 | Kroger Limited Partnership I | Pharmacy | 7223 Williamson Rd, Roanoke, VA 24019-4234 | 2006-07-10 |
| 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.