WISE COUNTY INTEGRATED CARE NPI 1174982193

NPI Information

NPI: 1174982193
Provider Name: WISE COUNTY INTEGRATED CARE
Classification: Clinic/Center - 261QP2300X
Specialization: Primary Care
Entity Type: Organization
CLIA Number: 49D2107107
Address: 43 CHAMPIONS AVE
SUITE 1
BIG STONE GAP, VA
ZIP 24219
Phone: (276) 523-8300

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NPI Details

WISE COUNTY INTEGRATED CARE is a primary care clinic center in Big Stone Gap, VA. WISE COUNTY INTEGRATED CARE NPI is 1174982193. The provider is registered as an organization entity type.

The provider's business location address is:

43 CHAMPIONS AVE
SUITE 1
BIG STONE GAP, VA
ZIP 24219-105
Phone: (276) 523-8300
Fax: (423) 467-3644

The provider's authorized official is Teresa Kidd .
The authorized official title is President & Ceo and has the following contact phone number (423) 467-3600.

The CLIA number assigned to this NPI record is 49D2107107 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/18/2016 and was last updated on 2/18/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	315-07-004	VIRGINIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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