Provider Demographics
NPI:1184807661
Name:MOUNTAIN EMPIRE OLDER CITIZENS, INC
Entity type:Organization
Organization Name:MOUNTAIN EMPIRE OLDER CITIZENS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:WAMPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-523-4202
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:1-A INDUSTRIAL PARK ROAD
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-0888
Mailing Address - Country:US
Mailing Address - Phone:276-523-4202
Mailing Address - Fax:276-523-4208
Practice Address - Street 1:1501 3RD AVE E
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3115
Practice Address - Country:US
Practice Address - Phone:276-523-4202
Practice Address - Fax:276-523-4208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
H5037OtherPACE