Provider Demographics
NPI:1902325913
Name:MUNSEY MEDICAL CLINIC INC
Entity type:Organization
Organization Name:MUNSEY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:540-480-9755
Mailing Address - Street 1:20 BOBBYS WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-4461
Mailing Address - Country:US
Mailing Address - Phone:540-480-9755
Mailing Address - Fax:
Practice Address - Street 1:20 BOBBYS WAY STE 105
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-4461
Practice Address - Country:US
Practice Address - Phone:540-480-9755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101059194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8918767Medicaid