Glen Edward Tate, MD is a medicare enrolled "Family Medicine" physician in Laurel Fork, Virginia. His current practice location is
14558 Danville Pike, Laurel Fork, Virginia. You can reach out to his office (for appointments etc.) via phone at
(276) 398-2292.
Glen Edward Tate is licensed to practice in Virginia (license number 0101034417) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1720082555.
Physician's Profile
| Full Name | Glen Edward Tate |
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| Gender | Male |
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| Speciality | Family Medicine |
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| Location | 14558 Danville Pike, Laurel Fork, Virginia |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1720082555
- Provider Enumeration Date: 06/09/2005
- Last Update Date: 03/05/2021
Medicare PECOS Information:
- PECOS PAC ID: 1254525421
- Enrollment ID: I20101101001532
Medical Identifiers
Medical identifiers for Glen Edward Tate such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1720082555 | NPI | - | NPPES |
| 007608942 | Medicaid | VA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 0101034417 (Virginia) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Glen Edward Tate allows following entities to bill medicare on his behalf.
| Entity Name | Tri Area Community Health |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1346227584
PECOS PAC ID: 6204748296
Enrollment ID: O20040122000969 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Glen Edward Tate is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Glen Edward Tate, MD
Po Box 9,
Laurel Fork, VA 24352-0009
Ph: (276) 398-2292 | Glen Edward Tate, MD
14558 Danville Pike,
Laurel Fork, VA 24352-3982
Ph: (276) 398-2292 |
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