Mountain Region Family Medicine Pc | |
142 Meade Avenue Nickelsville VA 24271 | |
(276) 479-2201 | |
(276) 479-3314 |
Full Name | Mountain Region Family Medicine Pc |
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Speciality | Family Medicine |
Location | 142 Meade Avenue, Nickelsville, Virginia |
Authorized Official Name and Position | Wanda Y Trent (CORPORATE SECRETARY) |
Authorized Official Contact | 4232243400 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Mountain Region Family Medicine Pc 142 Meade Avenue Nickelsville VA 24271 Ph: (276) 479-2201 | Mountain Region Family Medicine Pc 142 Meade Avenue Nickelsville VA 24271 Ph: (276) 479-2201 |
NPI Number | 1467565804 |
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Provider Enumeration Date | 08/17/2006 |
Last Update Date | 12/14/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467565804 | NPI | - | NPPES |
4175553 | Medicaid | TN | |
037069 | Other | VA | BLUE CROSS BLUE SHIELD |
265967710 | Other | TRICARE/CHAMPUS | |
5609933 | Medicaid | VA | |
0040096 | Other | TN | BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |