| Renaissance Medical Care | |
|
284 Blevins Blvd Bristol VA 24202-5977 | |
| (276) 285-3911 | |
| Not Available |
| Full Name | Renaissance Medical Care |
|---|---|
| Speciality | General Practice |
| Location | 284 Blevins Blvd, Bristol, Virginia |
| Authorized Official Name and Position | Linda Debord (OFFICE MANAGER) |
| Authorized Official Contact | 2762853911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Renaissance Medical Care 284 Blevins Blvd Bristol VA 24202-5977 Ph: (276) 285-3911 | Renaissance Medical Care 284 Blevins Blvd Bristol VA 24202-5977 Ph: (276) 285-3911 |
| NPI Number | 1649733387 |
|---|---|
| Provider Enumeration Date | 04/10/2019 |
| Last Update Date | 06/24/2019 |
| Medicare PECOS PAC ID | 2062748551 |
|---|---|
| Medicare Enrollment ID | O20190722001068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649733387 | NPI | - | NPPES |
| 0101249115 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | George O Halstead |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1942593603 PECOS PAC ID: 1254558877 Enrollment ID: I20190722001318 |
| Provider Name | Neal Ray Sanders |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1114115623 PECOS PAC ID: 4183923832 Enrollment ID: I20191113000412 |
| Provider Name | Tasha Nichole Herndon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780214049 PECOS PAC ID: 8022439082 Enrollment ID: I20200528003007 |
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