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DR. JOHN R WINE
>> Family Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1427040112
Individual Registrant:DR. JOHN R WINE
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
412 NAMOZINE STREET BURKEVILLE, VA 23922 US
Tel: 434-767-4822 Fax: 434-767-2211
Tel: 434-767-4822 Fax: 434-767-2211
Contact information for business:
PO BOX 927 WHITE SULPHUR SPRINGS, WV 24986-2373 US
Tel: 304-536-5030 Fax: 304-536-5031
Tel: 304-536-5030 Fax: 304-536-5031
Registration Information:
NPI: 1427040112
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | VA | 0101029100 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| AETNA | 4468872 | VA | 01 |
| CIGNA | 1108312 | VA | 01 |
| 1427040112 | VA | 05 | |
| BLACK LUNG/FECA | 61459602 | VA | 01 |
| 5633419 | VA | 05 | |
| ANTHEM | 345648 | VA | 01 |
