Organization
WISE COUNTY INTEGRATED CARE
Active
Parent organization
FRONTIER HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
FRONTIER HEALTH
Authorized official
DR. TERESA KIDD PHD (PRESIDENT & CEO)
(423) 467-3600
Entity
Organization
Contact information
Practice address
43 CHAMPIONS AVE, SUITE 1, BIG STONE GAP, VA 24219-1105
(276) 523-8300
(423) 467-3644
Mailing address
1167 SPRATLIN PARK DR, GRAY, TN 37615-6205
(423) 467-3600
(423) 467-3644
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
315-07-004
VA
Other
Enumeration date
02/18/2016
Last updated
02/18/2016
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