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16431 Wise Street Saint Paul VA 24283-3537 | |
(276) 762-2300 | |
(276) 762-0612 |
Full Name | |
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Speciality | Clinic/Center |
Location | 16431 Wise Street, Saint Paul, Virginia |
Authorized Official Name and Position | Shane Edwin Hilton (EVP/CFO) |
Authorized Official Contact | 4233023467 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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311 Princeton Rd Ste 1 Johnson City TN 37601-2026 Ph: (276) 762-2300 | 16431 Wise Street Saint Paul VA 24283-3537 Ph: (276) 762-2300 |
NPI Number | 1609054733 |
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Provider Enumeration Date | 01/31/2008 |
Last Update Date | 04/16/2024 |
Medicare PECOS PAC ID | 6002726718 |
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Medicare Enrollment ID | O20080317000508 |
Identifier | Type | State | Issuer |
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1609054733 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (Virginia) | Primary |