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235 Medical Dr Stanley VA 22851-4112 | |
(540) 778-1249 | |
(540) 743-9560 |
Full Name | |
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Speciality | Clinic/Center |
Location | 235 Medical Dr, Stanley, Virginia |
Authorized Official Name and Position | Renee Nevada Johnson (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 5405360103 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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220 Campus Blvd Ste 100 Winchester VA 22601-2896 Ph: () - | 235 Medical Dr Stanley VA 22851-4112 Ph: (540) 778-1249 |
NPI Number | 1598779571 |
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Provider Enumeration Date | 07/28/2006 |
Last Update Date | 02/24/2022 |
Medicare PECOS PAC ID | 8426951203 |
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Medicare Enrollment ID | O20101109001303 |
Identifier | Type | State | Issuer |
---|---|---|---|
1598779571 | NPI | - | NPPES |
007610181 | Medicaid | VA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (Virginia) | Primary |