Provider Demographics
NPI:1881930055
Name:MOUNTAIN EMPIRE OLDER CITZENS PACE
Entity type:Organization
Organization Name:MOUNTAIN EMPIRE OLDER CITZENS PACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-523-0599
Mailing Address - Street 1:PO BOX 888
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-0888
Mailing Address - Country:US
Mailing Address - Phone:276-523-0599
Mailing Address - Fax:276-523-4690
Practice Address - Street 1:1508 3RD AVE EAST
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-0888
Practice Address - Country:US
Practice Address - Phone:276-523-0599
Practice Address - Fax:276-523-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization