# PERFORMANCE MEDICINE OF SOUTHWEST

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Performance Medicine of Southwest Virginia, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679905467
- **Authorized official:** DELMAS J BOLIN M.D. (PRESIDENT)
- **Authorized official phone:** (540) 772-1890

## Contact information

- **Practice address:** 25 W CALHOUN ST, SALEM, VA 24153-3836
- **Practice address phone:** (540) 772-1890
- **Practice address fax:** (540) 772-1893
- **Mailing address:** 25 W CALHOUN ST, SALEM, VA 24153-3836
- **Mailing address phone:** (540) 772-1890
- **Mailing address fax:** (540) 772-1893

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

- **Enumeration date:** 08/02/2013
- **Last updated:** 05/23/2024