Organization
MOUNTAIN REGION FAMILY MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELLE Y REPASS (ADMINISTRATIVE ASSISTANT)
(276) 386-3411
Entity
Organization
Contact information
Practice address
390 KANE ST, GATE CITY, VA 24251-3407
(276) 386-3411
(276) 286-2492
Mailing address
390 KANE ST, GATE CITY, VA 24251-2753
(276) 386-3411
(276) 386-3492
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037070
ANTHEM BLUE CROSS
—
05
—
4401019
—
TN
01
—
CA3908
RAILROAD MEDICARE
—
Enumeration date
08/12/2006
Last updated
02/16/2016
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