| Arh Pennington Gap Clinic | |
|
121 Stacy Drive Pennington Gap VA 24277 | |
| (276) 546-1182 | |
| (606) 439-6987 |
| Full Name | Arh Pennington Gap Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 121 Stacy Drive, Pennington Gap, Virginia |
| Authorized Official Name and Position | Hollie Harris (PRESIDENT AND CEO) |
| Authorized Official Contact | 8592262511 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arh Pennington Gap Clinic 121 Stacy Drive Pennington Gap VA 24277 Ph: (276) 546-1182 | Arh Pennington Gap Clinic 121 Stacy Drive Pennington Gap VA 24277 Ph: (276) 546-1182 |
| NPI Number | 1063821288 |
|---|---|
| Provider Enumeration Date | 08/13/2014 |
| Last Update Date | 09/20/2024 |
| Medicare PECOS PAC ID | 0840107835 |
|---|---|
| Medicare Enrollment ID | O20150902000098 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063821288 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Dusta L Boggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558301572 PECOS PAC ID: 0143226738 Enrollment ID: I20061004000213 |
| Provider Name | Ashley N Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356781900 PECOS PAC ID: 8527200245 Enrollment ID: I20150902000716 |
| Provider Name | Jose M Echeverria |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215929575 PECOS PAC ID: 2163559998 Enrollment ID: I20160812002079 |
| Provider Name | Mary Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588183156 PECOS PAC ID: 5496011405 Enrollment ID: I20220110000113 |
| Provider Name | Haley Overbay |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659033215 PECOS PAC ID: 3072906304 Enrollment ID: I20220209002825 |
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