| Msmg Fp Glde | |
|
636 S Monte Vista Dr Glade Spring VA 24340-2712 | |
| (276) 429-5163 | |
| (276) 429-5515 |
| Full Name | Msmg Fp Glde |
|---|---|
| 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 |
|---|---|
| Msmg Fp Glde 636 S Monte Vista Dr Glade Spring VA 24340-2712 Ph: (276) 429-5163 | Msmg Fp Glde 636 S Monte Vista Dr Glade Spring VA 24340-2712 Ph: (276) 429-5163 |
| NPI Number | 1942630082 |
|---|---|
| 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 |
Bhrhc Glade Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 636 S Monte Vista Dr, Glade Spring, VA 24340 Phone: 276-429-5163 Fax: 276-429-5515 |