| Maryville Interventional Psychiatry Pllc | |
|
2211 E Broadway Ave Maryville TN 37804-3078 | |
| (865) 269-7582 | |
| (865) 233-9046 |
| Full Name | Maryville Interventional Psychiatry Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2211 E Broadway Ave, Maryville, Tennessee |
| Authorized Official Name and Position | Justin Lapollo (PSYCHIATRIST) |
| Authorized Official Contact | 8659513927 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maryville Interventional Psychiatry Pllc 2211 E Broadway Ave Maryville TN 37804-3078 Ph: (865) 269-7582 | Maryville Interventional Psychiatry Pllc 2211 E Broadway Ave Maryville TN 37804-3078 Ph: (865) 269-7582 |
| NPI Number | 1184359747 |
|---|---|
| Provider Enumeration Date | 07/19/2022 |
| Last Update Date | 10/11/2023 |
| Certification Date | 10/11/2023 |
| Medicare PECOS PAC ID | 9133504285 |
|---|---|
| Medicare Enrollment ID | O20220909003147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184359747 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Erin R. Borum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013488519 PECOS PAC ID: 7719225317 Enrollment ID: I20190206001063 |
| Provider Name | Summer L Rhodes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699306290 PECOS PAC ID: 1557799046 Enrollment ID: I20200316002092 |
| Provider Name | Justin Lapollo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811124340 PECOS PAC ID: 6204062276 Enrollment ID: I20210609002889 |
| Provider Name | Ricki Bell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932837242 PECOS PAC ID: 3971989112 Enrollment ID: I20220926002638 |
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