Individual
JOE M PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
JACKSON RIVER ORTHOPEDICS, 1 ARH LANE, STE 102, LOW MOOR, VA 24457
(540) 862-6777
(540) 863-9167
Mailing address
PO BOX 457, 5 E ALVON ROAD, SUITE 7, WHITE SULPHUR SPRINGS, WV 24986-2373
(304) 536-5030
(304) 536-5031
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0102201406
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006409806
—
VA
01
—
200026
LUNG
—
01
—
213824
CARELINK
—
05
—
3003781000
—
WV
01
—
465498
ANTHEM
VA
01
—
465499
ANTHEM
WV
01
—
541839718
C&O
—
01
—
54183971800
WV WORKERS COMPENSATION
WV
01
—
541839718103
BS MOUNTAIN STATE
WV
01
—
541839718104
BS MOUNTAIN STATE
VA
01
—
5431529
CCN
—
01
—
7194496
AETNA
—
Enumeration date
06/16/2005
Last updated
10/15/2011
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