| Calvary Medical | |
|
1582 N Broad St Suite 2 Tazewell TN 37879-4352 | |
| (423) 626-0277 | |
| (423) 626-0082 |
| Full Name | Calvary Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 1582 N Broad St, Tazewell, Tennessee |
| Authorized Official Name and Position | Gary Wayne Brown (OWNER) |
| Authorized Official Contact | 4236260277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Calvary Medical 1582 N Broad St Ste 2 Tazewell TN 37879-4352 Ph: (423) 626-0277 | Calvary Medical 1582 N Broad St Suite 2 Tazewell TN 37879-4352 Ph: (423) 626-0277 |
| NPI Number | 1366997637 |
|---|---|
| Provider Enumeration Date | 08/16/2016 |
| Last Update Date | 06/26/2024 |
| Medicare PECOS PAC ID | 1153668959 |
|---|---|
| Medicare Enrollment ID | O20190205001321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366997637 | NPI | - | NPPES |
| APN 14103 | Other | TN | APN LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | APN14103 (Tennessee) | Primary |
| Provider Name | Gary W Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396988762 PECOS PAC ID: 4688725385 Enrollment ID: I20090618000790 |
| Provider Name | Amy Howe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225540495 PECOS PAC ID: 7911250618 Enrollment ID: I20181026000353 |
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