| Mountain Region Family Medicine Pc | |
|
142 Meade Avenue Nickelsville VA 24271 | |
| (276) 479-2201 | |
| (276) 479-3314 |
| Full Name | Mountain Region Family Medicine Pc |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |