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Organization

RENAISSANCE MEDICAL CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GEORGE OLIVER HALSTEAD M.D. (PRESIDENT)
(276) 285-3911
Entity
Organization

Contact information

Practice address
284 BLEVINS BOULEVARD, BRISTOL, VA 24202
(276) 285-3911
(276) 285-3920
Mailing address
284 BLEVINS BOULEVARD, BRISTOL, VT 24202
(276) 285-3911
(276) 285-3920

Taxonomy

Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
208D00000X
General Practice Physician
Primary

Other

Enumeration date
12/07/2017
Last updated
03/25/2019
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