Organization
COUNTY MED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANTEL LATTA NP (OWNER)
(434) 294-3825
Entity
Organization
Contact information
Practice address
103 E BROAD ST, BLACKSTONE, VA 23824-1815
(434) 264-3221
Mailing address
PO BOX 635, BLACKSTONE, VA 23824-0635
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30017485050002
—
VA
Enumeration date
07/14/2022
Last updated
08/01/2023
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