Wynn Medical Center
Organization Active NPI Health Service Clinic/Center · Duffield, VA
NPI 1457056566 · NPPES record last updated May 30, 2024
Key facts
- NPI
- 1457056566
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Service Clinic/Center 261QH0100X
- Legal business name
- WYNN MEDICAL CENTER
- Practice address
- 225 Boone Trail Rd
Suite 200
Duffield, VA 24244 - Phone
- (276) 231-9228
- NPI assigned
- Mar 31, 2023
- Organization subpart
- No
Authorized official
- Name
- Lisa Ann Wynn, FNP
- Title
- Provider
- Phone
- (276) 231-9228
Practitioners 37
-
Lisa Ann Wynn, APRN
-
Mehran Bajoghli, M.D.
-
Jennifer Lee Barnett, NP-C
-
Ramona L Boyd, NP
-
Shawn Dale Boyd, FNP-BC
-
Tammy Ann Branham, FNP
-
Elizabeth K Davenport, LCSW
-
Denny Ray Goss II, M.D.
-
Jennifer Lynn Hatfield-Adkins, MSN, APRN, FNP-C
-
Angelia Hopkins, RN, MSN
-
David M Mitchell, MD PHD
-
Kaitlyn Mullins, FNP-C
-
Katie Newsome-Deel, APRN
-
Sidney Sparks, FNP
-
Allison Heather Stanley, FNP-C
-
Ashley Stanley, FNP-BC
-
Natasha Stanley, FNP
-
Cynthia Renee Taylor, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2280429 | Wynn Medical Center PLLC | Certificate of waiver | Apr 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230412001526 | VA | Part B Supplier - Clinic/Group Practice | 8224403860 |
Receives reassigned benefits from 1 practitioner Practice locations: Duffield, VA |
National Provider Directory
Locations
41718 W Morgan Ave
Pennington Gap, VA 24277
145 Dollar Dr
Pennington Gap, VA 24277
Phone 2762319228 ext. 1001
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | Yes |
Addresses
Primary practice location
225 Boone Trail Rd
Suite 200
Duffield, VA 24244
Mailing address
PO Box 408
Duffield, VA 24244-0408
Phone (276) 231-9227
Other practice location 1
145 Dollar Dr
Pennington Gap, VA 24277-7230
Phone (276) 231-9228 ext. 1001
Other providers in Duffield, VA
- Village Economy Drug Inc
- Elois P Wampler
- Watauga Duffield Medical Center, P.C.
- James Bryston Winegar
- Rebecca Lynn Wolford
All providers in Duffield, VA · Health Service Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.