Dba: Piney Flats Urgent Care | |
6419 Bristol Highway Piney Flats TN 37686 | |
(423) 538-5202 | |
(423) 538-8208 |
Full Name | Dba: Piney Flats Urgent Care |
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Speciality | Clinic/Center |
Location | 6419 Bristol Highway, Piney Flats, Tennessee |
Authorized Official Name and Position | Charles L Backus (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 4235385202 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Dba: Piney Flats Urgent Care 509 Medtech Pkwy Johnson City TN 37604 Ph: (423) 952-2122 | Dba: Piney Flats Urgent Care 6419 Bristol Highway Piney Flats TN 37686 Ph: (423) 538-5202 |
NPI Number | 1356379093 |
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Provider Enumeration Date | 06/29/2006 |
Last Update Date | 01/28/2022 |
Medicare PECOS PAC ID | 3870560741 |
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Medicare Enrollment ID | O20040911000150 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356379093 | NPI | - | NPPES |
3726460 | Medicaid | TN | |
DD0861 | Other | TN | RR |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Secondary |
261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
Provider Name | Charles L Backus |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1801856414 PECOS PAC ID: 8729070107 Enrollment ID: I20040402001281 |
Provider Name | James M Shipley |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1912957937 PECOS PAC ID: 4486673019 Enrollment ID: I20051114000386 |
Provider Name | James C Glass |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1336389824 PECOS PAC ID: 4284782152 Enrollment ID: I20090501000519 |
Provider Name | Mary Catherine Shipley |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1578107181 PECOS PAC ID: 8224459003 Enrollment ID: I20200603000958 |
Provider Name | Taylor Alese Holbrook |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1184254179 PECOS PAC ID: 8921410168 Enrollment ID: I20201214000375 |
Provider Name | Jean Inderfurth |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1851959712 PECOS PAC ID: 6002145695 Enrollment ID: I20220503000468 |
Provider Name | Elizabeth Ann Honeycutt-martin |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1346993482 PECOS PAC ID: 6002292992 Enrollment ID: I20220929002250 |
Provider Name | Eden Marie Villiard |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1164144937 PECOS PAC ID: 2062882392 Enrollment ID: I20230103001744 |
Provider Name | Andrea R Hooper |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871234500 PECOS PAC ID: 8820455595 Enrollment ID: I20230612001812 |
Fast Pace Medical Clinic Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5554 Highway 11 E, Piney Flats, TN 37686 Phone: 423-666-0030 Fax: 423-666-0031 |