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636 S Monte Vista Dr Glade Spring VA 24340-2712 | |
(276) 429-5163 | |
(276) 429-5515 |
Full Name | |
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Speciality | Family Medicine |
Location | 636 S Monte Vista Dr, Glade Spring, Virginia |
Authorized Official Name and Position | Marvin H Eichorn (SENIOR VP AND CFO) |
Authorized Official Contact | 4234311017 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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636 S Monte Vista Dr Glade Spring VA 24340-2712 Ph: (276) 429-5163 | 636 S Monte Vista Dr Glade Spring VA 24340-2712 Ph: (276) 429-5163 |
NPI Number | 1942630082 |
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Provider Enumeration Date | 11/26/2013 |
Last Update Date | 02/14/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942630082 | NPI | - | NPPES |
1073519377 | Medicaid | VA | |
DV0636 | Other | VA | RAILROAD MEDICARE |
DH1427 | Other | VA | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |