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Organization

MOUNTAIN EMPIRE OLDER CITIZENS, INC

Active
Other names
Mountain Empire PACE
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL K WAMPLER (EXECUTIVE DIRECTOR)
(276) 523-4202
Entity
Organization

Contact information

Practice address
1501 3RD AVE E, BIG STONE GAP, VA 24219-3115
(276) 523-4202
(276) 523-4208
Mailing address
PO BOX 888, 1-A INDUSTRIAL PARK ROAD, BIG STONE GAP, VA 24219-0888
(276) 523-4202
(276) 523-4208

Taxonomy

Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
H5037
PACE
Enumeration date
12/07/2007
Last updated
06/28/2022
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