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391 Court Sq Sneedville TN 37869-0723 | |
(423) 733-2819 | |
(423) 733-8509 |
Full Name | |
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Speciality | Clinic/Center |
Location | 391 Court Sq, Sneedville, Tennessee |
Authorized Official Name and Position | Betty J. King (ACTING CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 4234394414 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 70403 365 Stout Drive Johnson City TN 37614-1703 Ph: (423) 439-4515 | 391 Court Sq Sneedville TN 37869-0723 Ph: (423) 733-2819 |
NPI Number | 1326142563 |
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Provider Enumeration Date | 09/08/2006 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 2769394774 |
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Medicare Enrollment ID | O20031002000000 |
Identifier | Type | State | Issuer |
---|---|---|---|
1326142563 | NPI | - | NPPES |
3709292 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Secondary |