| Blue Ridge Long Term Care Associates, Plc | |
|
210 Elm Ave Louisa VA 23093-6578 | |
| (434) 242-7077 | |
| Not Available |
| Full Name | Blue Ridge Long Term Care Associates, Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 210 Elm Ave, Louisa, Virginia |
| Authorized Official Name and Position | Mary Palmquist Evans (PRESIDENT) |
| Authorized Official Contact | 4342427077 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Ridge Long Term Care Associates, Plc Po Box 6126 Charlottesville VA 22901-6126 Ph: (434) 242-7077 | Blue Ridge Long Term Care Associates, Plc 210 Elm Ave Louisa VA 23093-6578 Ph: (434) 242-7077 |
| NPI Number | 1487622528 |
|---|---|
| Provider Enumeration Date | 03/14/2006 |
| Last Update Date | 04/01/2009 |
| Medicare PECOS PAC ID | 7113970856 |
|---|---|
| Medicare Enrollment ID | O20050223000070 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487622528 | NPI | - | NPPES |
| 010155827 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | 0101233405 (Virginia) | Primary |
| Provider Name | Mary Palmquist Evans |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1346219029 PECOS PAC ID: 2961395280 Enrollment ID: I20040202001132 |
| Provider Name | Jonathan M Evans |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184793705 PECOS PAC ID: 3173531340 Enrollment ID: I20060329000582 |
Health & Wellness Center Of Louisa Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 410 Industrial Drive, Louisa, VA 23093 Phone: 434-581-3271 | |
Louisa Family Practice, Plc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 101 Woolfolk Avenue, Louisa, VA 23093 Phone: 540-967-2202 Fax: 540-967-1676 |