| |
111 Fashion Rd Ste D Pounding Mill VA 24637-1200 | |
(276) 596-6375 | |
(276) 963-0920 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 111 Fashion Rd Ste D, Pounding Mill, Virginia |
Authorized Official Name and Position | Charlotte Lawrence (SECRETARY) |
Authorized Official Contact | 6159207000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
330 Seven Springs Way Brentwood TN 37027-5098 Ph: (615) 920-7000 | 111 Fashion Rd Ste D Pounding Mill VA 24637-1200 Ph: (276) 596-6375 |
NPI Number | 1386329902 |
---|---|
Provider Enumeration Date | 06/20/2023 |
Last Update Date | 09/24/2024 |
Medicare PECOS PAC ID | 9436259223 |
---|---|
Medicare Enrollment ID | O20230721001729 |
Identifier | Type | State | Issuer |
---|---|---|---|
1386329902 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |