Mountain Region Family Medicine Pc | |
142 Meade Avenue Nickelsville VA 24271 | |
(276) 479-2201 | |
(276) 479-3314 |
Full Name | Mountain Region Family Medicine Pc |
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Speciality | Family Medicine |
Location | 142 Meade Avenue, Nickelsville, Virginia |
Authorized Official Name and Position | Wanda Y Trent (CORPORATE SECRETARY) |
Authorized Official Contact | 4232243400 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Mountain Region Family Medicine Pc 142 Meade Avenue Nickelsville VA 24271 Ph: (276) 479-2201 | Mountain Region Family Medicine Pc 142 Meade Avenue Nickelsville VA 24271 Ph: (276) 479-2201 |
NPI Number | 1467565804 |
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Provider Enumeration Date | 08/17/2006 |
Last Update Date | 12/14/2017 |
Medicare PECOS PAC ID | 5890699961 |
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Medicare Enrollment ID | O20031120000676 |
Identifier | Type | State | Issuer |
---|---|---|---|
1467565804 | NPI | - | NPPES |
4175553 | Medicaid | TN | |
037069 | Other | VA | BLUE CROSS BLUE SHIELD |
265967710 | Other | TRICARE/CHAMPUS | |
5609933 | Medicaid | VA | |
0040096 | Other | TN | BLUE CROSS BLUE SHIELD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Wesley V Eastridge |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457313439 PECOS PAC ID: 5799689873 Enrollment ID: I20050103000884 |
Provider Name | Bruce S Vincent |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1538110309 PECOS PAC ID: 8224088711 Enrollment ID: I20050122000097 |
Provider Name | Andy Delwadia |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1629089784 PECOS PAC ID: 5496707598 Enrollment ID: I20050217000138 |
Provider Name | Aaron K Metcalf |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1164582862 PECOS PAC ID: 2860588167 Enrollment ID: I20071018000110 |
Provider Name | Michael P Kauzlarich |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1477539542 PECOS PAC ID: 0042380073 Enrollment ID: I20080603000581 |
Provider Name | Kevin D Misischia |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1356391098 PECOS PAC ID: 4789767807 Enrollment ID: I20100303000056 |
Provider Name | Eric Harman |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1588676456 PECOS PAC ID: 7315020435 Enrollment ID: I20100318000234 |
Provider Name | Gregory L Demotts |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1891708111 PECOS PAC ID: 5799889747 Enrollment ID: I20100924000102 |
Provider Name | Roger W Archer |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1508877846 PECOS PAC ID: 3779666896 Enrollment ID: I20100924000804 |
Provider Name | Richard L Brandon |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1265443436 PECOS PAC ID: 1052494176 Enrollment ID: I20100927000967 |
Provider Name | Monika Karakattu |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1881854594 PECOS PAC ID: 5698944072 Enrollment ID: I20130820000237 |
Provider Name | Kimberly D Roller |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1457544868 PECOS PAC ID: 0345306585 Enrollment ID: I20130829000309 |
Provider Name | Amber Gourley |
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Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
Provider Identifiers | NPI Number: 1760814271 PECOS PAC ID: 0244468189 Enrollment ID: I20140122001323 |
Provider Name | Leslie Brooke Mcnew-hall |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811303563 PECOS PAC ID: 3577784958 Enrollment ID: I20150428000441 |
Provider Name | Monna J. Nelms |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1205205317 PECOS PAC ID: 6901115799 Enrollment ID: I20151019000007 |
Provider Name | Sean Joseph Watson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1912325127 PECOS PAC ID: 9234430828 Enrollment ID: I20151228000852 |
Provider Name | Carli J Cooper |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1861732968 PECOS PAC ID: 1658505375 Enrollment ID: I20160809000470 |
Provider Name | Amanda M Malone |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1033537428 PECOS PAC ID: 0840557948 Enrollment ID: I20171128001124 |
Provider Name | Katelyn M Spitler |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1952851784 PECOS PAC ID: 0446539084 Enrollment ID: I20180130002052 |
Provider Name | Brent A Baker |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1003270968 PECOS PAC ID: 3971868076 Enrollment ID: I20180518002346 |
Provider Name | Zachary Linuel Sumpter |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1114380771 PECOS PAC ID: 9638434087 Enrollment ID: I20180605003450 |
Provider Name | Alysen M Carter |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1194110346 PECOS PAC ID: 4880941814 Enrollment ID: I20181108002876 |