| 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 | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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 |
| Medicare PECOS PAC ID | 5890699961 |
|---|---|
| Medicare Enrollment ID | O20070328000689 |
| 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 |
| Provider Name | Gregory L Demotts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891708111 PECOS PAC ID: 5799889747 Enrollment ID: I20100923001253 |
| Provider Name | Katelyn M Spitler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952851784 PECOS PAC ID: 0446539084 Enrollment ID: I20180222001516 |
| Provider Name | Monna J. Nelms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205205317 PECOS PAC ID: 6901115799 Enrollment ID: I20190723002378 |