| Eastlake Primary Care | |
|
2500 Jacksboro Pike Ste 6 Jacksboro TN 37757-2818 | |
| (423) 352-6500 | |
| (423) 352-6501 |
| Full Name | Eastlake Primary Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 2500 Jacksboro Pike Ste 6, Jacksboro, Tennessee |
| Authorized Official Name and Position | Valerie Lynn Miesel (OWNER) |
| Authorized Official Contact | 4233526500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastlake Primary Care 2500 Jacksboro Pike Suite 6 Jacksboro TN 37757 Ph: (423) 352-6500 | Eastlake Primary Care 2500 Jacksboro Pike Ste 6 Jacksboro TN 37757-2818 Ph: (423) 352-6500 |
| NPI Number | 1972043214 |
|---|---|
| Provider Enumeration Date | 03/06/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 1254752371 |
|---|---|
| Medicare Enrollment ID | O20200528000649 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972043214 | NPI | - | NPPES |
| Q027747 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Tennessee) | Primary |
| Provider Name | Ryan A Unger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891926440 PECOS PAC ID: 8628227568 Enrollment ID: I20121009000340 |
| Provider Name | Cara Jean Mccullah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497144968 PECOS PAC ID: 8224358502 Enrollment ID: I20150528000818 |
| Provider Name | Sandra R Bond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780185686 PECOS PAC ID: 3375896657 Enrollment ID: I20181102002370 |
| Provider Name | Iesha Marlena Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023649662 PECOS PAC ID: 8123430071 Enrollment ID: I20201217000448 |
Mercy Women's Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2500 Jacksboro Pike, Suite 30, Jacksboro, TN 37757 Phone: 423-907-1685 Fax: 423-907-1688 | |
Lafollette Health Clinic Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2503 Jacksboro Pike, Jacksboro, TN 37757 Phone: 423-566-6466 Fax: 423-566-1387 | |
Appa Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3170 Appalachian Hwy, Jacksboro, TN 37757 Phone: 404-862-4866 | |
Mercy Women's Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2500 Jacksboro Pike, Suite 30, Jacksboro, TN 37757 Phone: 423-907-1685 Fax: 423-907-1688 | |
Neighborhood Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2702 Jacksboro Pike, Suite B, Jacksboro, TN 37757 Phone: 423-201-9937 |