| Mountain Psychiatric, Llc | |
|
5115 Bernard Dr Suite 105 Roanoke VA 24018-4357 | |
| (540) 728-1570 | |
| Not Available |
| Full Name | Mountain Psychiatric, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5115 Bernard Dr, Roanoke, Virginia |
| Authorized Official Name and Position | Jennifer Colorado (CREDENTIALING) |
| Authorized Official Contact | 8324946448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Psychiatric, Llc 5115 Bernard Dr Suite 105 Roanoke VA 24018-4357 Ph: (540) 728-1570 | Mountain Psychiatric, Llc 5115 Bernard Dr Suite 105 Roanoke VA 24018-4357 Ph: (540) 728-1570 |
| NPI Number | 1720404841 |
|---|---|
| Provider Enumeration Date | 03/13/2014 |
| Last Update Date | 03/19/2014 |
| Medicare PECOS PAC ID | 5294952545 |
|---|---|
| Medicare Enrollment ID | O20140808001944 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720404841 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jason C Grove |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982801288 PECOS PAC ID: 7315115250 Enrollment ID: I20140808002124 |
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