| 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 | O20031120000676 |
| 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 | Wesley V Eastridge |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457313439 PECOS PAC ID: 5799689873 Enrollment ID: I20050103000884 |
| Provider Name | Bruce S Vincent |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538110309 PECOS PAC ID: 8224088711 Enrollment ID: I20050122000097 |
| Provider Name | Andy Delwadia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629089784 PECOS PAC ID: 5496707598 Enrollment ID: I20050217000138 |
| Provider Name | Aaron K Metcalf |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164582862 PECOS PAC ID: 2860588167 Enrollment ID: I20071018000110 |
| Provider Name | Michael P Kauzlarich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1477539542 PECOS PAC ID: 0042380073 Enrollment ID: I20080603000581 |
| Provider Name | Kevin D Misischia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356391098 PECOS PAC ID: 4789767807 Enrollment ID: I20100303000056 |
| Provider Name | Eric Harman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588676456 PECOS PAC ID: 7315020435 Enrollment ID: I20100318000234 |
| Provider Name | Gregory L Demotts |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891708111 PECOS PAC ID: 5799889747 Enrollment ID: I20100924000102 |
| Provider Name | Roger W Archer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508877846 PECOS PAC ID: 3779666896 Enrollment ID: I20100924000804 |
| Provider Name | Richard L Brandon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265443436 PECOS PAC ID: 1052494176 Enrollment ID: I20100927000967 |
| Provider Name | Monika Karakattu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881854594 PECOS PAC ID: 5698944072 Enrollment ID: I20130820000237 |
| Provider Name | Kimberly D Roller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457544868 PECOS PAC ID: 0345306585 Enrollment ID: I20130829000309 |
| Provider Name | Amber Gourley |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1760814271 PECOS PAC ID: 0244468189 Enrollment ID: I20140122001323 |
| Provider Name | Leslie Brooke Mcnew-hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811303563 PECOS PAC ID: 3577784958 Enrollment ID: I20150428000441 |
| Provider Name | Monna J. Nelms |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205205317 PECOS PAC ID: 6901115799 Enrollment ID: I20151019000007 |
| Provider Name | Sean Joseph Watson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912325127 PECOS PAC ID: 9234430828 Enrollment ID: I20151228000852 |
| Provider Name | Carli J Cooper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861732968 PECOS PAC ID: 1658505375 Enrollment ID: I20160809000470 |
| Provider Name | Amanda M Malone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033537428 PECOS PAC ID: 0840557948 Enrollment ID: I20171128001124 |
| Provider Name | Katelyn M Spitler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952851784 PECOS PAC ID: 0446539084 Enrollment ID: I20180130002052 |
| Provider Name | Brent A Baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003270968 PECOS PAC ID: 3971868076 Enrollment ID: I20180518002346 |
| Provider Name | Zachary Linuel Sumpter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114380771 PECOS PAC ID: 9638434087 Enrollment ID: I20180605003450 |
| Provider Name | Alysen M Carter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194110346 PECOS PAC ID: 4880941814 Enrollment ID: I20181108002876 |