Prof Michael C Vacco, MD | |
1980 Holton Ave E, Suite 203, Big Stone Gap, VA 24219-3366 | |
(276) 523-8681 | |
(276) 523-8684 |
Full Name | Prof Michael C Vacco |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 1980 Holton Ave E, Big Stone Gap, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1447222922 | NPI | - | NPPES |
010157617 | Medicaid | VA | |
64103930 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 0101237952 (Virginia) | Primary |
Entity Name | Wellmont Medical Associates Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1174808216 PECOS PAC ID: 8123291739 Enrollment ID: O20120627000467 |
Entity Name | Clinch Valley Physicians Associates Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1104265214 PECOS PAC ID: 9133146111 Enrollment ID: O20130821001053 |
Mailing Address | Practice Location Address |
---|---|
Prof Michael C Vacco, MD 999 Executive Park Blvd, Suite 201, Kingsport, TN 37660-4632 Ph: (423) 224-3250 | Prof Michael C Vacco, MD 1980 Holton Ave E, Suite 203, Big Stone Gap, VA 24219-3366 Ph: (276) 523-8681 |
Dr. Rhonda Kincaid Bass, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 3169 2nd Avenue East, Big Stone Gap, VA 24219 Phone: 276-523-8300 | |
Bernard Manatu, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 320 Cloverleaf Sq, Bldg D3, Big Stone Gap, VA 24219 Phone: 276-524-1785 Fax: 276-524-1787 |