# MOUNTAIN REGION FAMILY MEDICINE, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MRFM- Gate City Weekend Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316572530
- **Authorized official:** WANDA TRENT (CORPORATE SECRETARY)
- **Authorized official phone:** (423) 230-2109

## Contact information

- **Practice address:** 390 KANE ST, GATE CITY, VA 24251-2753
- **Practice address phone:** (276) 386-3411
- **Practice address fax:** (276) 386-3492
- **Mailing address:** 444 CLINCHFIELD ST STE 201, KINGSPORT, TN 37660-3863
- **Mailing address phone:** (423) 230-2113
- **Mailing address fax:** (423) 230-2112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/09/2020
- **Last updated:** 03/09/2020