| Laurel Fork Family Practice | |
|
1205 Stone Mountain Road Laurel Fork VA 24352 | |
| (276) 398-2532 | |
| (276) 398-2534 |
| Full Name | Laurel Fork Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 1205 Stone Mountain Road, Laurel Fork, Virginia |
| Authorized Official Name and Position | John William Tracy (OWNER) |
| Authorized Official Contact | 2763982532 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Laurel Fork Family Practice Po Box 85 Laurel Fork VA 24352-0085 Ph: (276) 398-2532 | Laurel Fork Family Practice 1205 Stone Mountain Road Laurel Fork VA 24352 Ph: (276) 398-2532 |
| NPI Number | 1336639657 |
|---|---|
| Provider Enumeration Date | 05/11/2018 |
| Last Update Date | 05/11/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336639657 | NPI | - | NPPES |
| 190001221 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101236128 (Virginia) | Primary |
Tri Area Community Health At Laurel Fork Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 14558 Danville Pike, Laurel Fork, VA 24352 Phone: 276-398-2292 Fax: 276-398-3331 |