| Organization Name: | WISE COUNTY INTEGRATED CARE |
| NPI Number: | 1174982193 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERESA KIDD (PRESIDENT & CEO) |
| Mailing Address: | 43 Champions Ave Suite 1 Big Stone Gap |
| State: | VA US |
| Postal Code: | 242191105 |
| Phone Number: | 2765238300 |
| Fax Number: | 4234673644 |
| NPI Enumeration Date: | 02/18/2016 |
| NPI Last Update Date: | 02/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 315-07-004 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |