Active NPI
Mountain Region Family Medicine PC
- Family Medicine Physician
- Nickelsville, VA
National Provider Identifier
1467565804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MOUNTAIN REGION FAMILY MEDICINE PC
- Practice address
- 142 Meade Avenue
Nickelsville, VA 24271 - Phone
- (276) 479-2201
- Fax
- (276) 479-3314
- NPI assigned
- Aug 17, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Wanda Y Trent
- Title
- Corporate Secretary
- Phone
- (423) 224-3400
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
142 Meade Avenue
Nickelsville, VA 24271
Mailing address
142 Meade Avenue
Nickelsville, VA 24271
Phone (276) 479-2201
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4175553 | Medicaid | TN | |
| 037069 | Other | VA | BLUE CROSS BLUE SHIELD |
| 265967710 | Other | TRICARE/CHAMPUS | |
| 5609933 | Medicaid | VA | |
| 0040096 | Other | TN | BLUE CROSS BLUE SHIELD |
National Provider Directory
National Provider DirectoryLocations
142 Meade Ave
Nickelsville, VA 24271
Phone (276) 479-2201
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1513209600000",
"number": "1467565804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "142 MEADE AVENUE",
"city": "NICKELSVILLE",
"state": "VA",
"postal_code": "24271",
"telephone_number": "276-479-2201",
"fax_number": "276-479-3314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "142 MEADE AVENUE",
"city": "NICKELSVILLE",
"state": "VA",
"postal_code": "24271",
"telephone_number": "276-479-2201",
"fax_number": "276-479-3314"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOUNTAIN REGION FAMILY MEDICINE PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-17",
"last_updated": "2017-12-14",
"status": "A",
"authorized_official_last_name": "TRENT",
"authorized_official_first_name": "WANDA",
"authorized_official_middle_name": "Y",
"authorized_official_title_or_position": "CORPORATE SECRETARY",
"authorized_official_telephone_number": "423-224-3400"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4175553",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "037069",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE/CHAMPUS",
"identifier": "265967710",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5609933",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0040096",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nickelsville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.