COUNTY MED, LLC
NPI 1407580483
Clinic/Center - Primary Care in Blackstone, VA
About County Med, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
COUNTY MED, LLC (NPI 1407580483) is a healthcare organization registered as a primary care in Blackstone, Virginia and active in the NPI registry since July 2022. The organization holds a CLIA Waiver certificate valid through December 11, 2026 and lists Shantel Latta, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
County Med, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to County Med, LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 49D2273322
County Med, LLC · Blackstone, VAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is County Med, LLC's NPI number?
The NPI number for County Med, LLC is 1407580483. It was assigned to this organization in the NPPES registry on July 14, 2022.
Where is County Med, LLC located?
County Med, LLC is located at 103 E Broad St, Blackstone, VA 23824. The listed phone number is (434) 264-3221.
What is County Med, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is County Med, LLC enrolled in Medicare?
Yes. County Med, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through County Med, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to County Med, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does County Med, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 49D2273322) is associated with this NPI, valid through December 11, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for County Med, LLC was last updated on August 1, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# County Med, Llc · NPI 1407580483
Primary Care organization in Blackstone, Virginia. Organization record, active in the CMS NPPES registry since July 14, 2022.
## Identity
- **NPI:** 1407580483 (Entity type: Organization)
- **Enumerated:** July 14, 2022
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Shantel Latta, OWNER
## Practice location
- **Address:** 103 E BROAD ST, Blackstone, VA 23824-1815
- **Phone:** (434) 264-3221
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 1, 2023
- **Other identifiers:** Medicaid 30017485050002 (VA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1407580483) · Data from the CMS NPPES public registry.