| Marble City Medical Pllc | |
|
7500 Dodson Rd Knoxville TN 37920-9734 | |
| (865) 339-4053 | |
| (865) 859-0326 |
| Full Name | Marble City Medical Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7500 Dodson Rd, Knoxville, Tennessee |
| Authorized Official Name and Position | Courtney Blackwell Mcleod (OWNER) |
| Authorized Official Contact | 8653394053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marble City Medical Pllc 7500 Dodson Rd Knoxville TN 37920-9734 Ph: (865) 339-4053 | Marble City Medical Pllc 7500 Dodson Rd Knoxville TN 37920-9734 Ph: (865) 339-4053 |
| NPI Number | 1760940613 |
|---|---|
| Provider Enumeration Date | 03/11/2019 |
| Last Update Date | 09/13/2022 |
| Medicare PECOS PAC ID | 5991039166 |
|---|---|
| Medicare Enrollment ID | O20190620003203 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760940613 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Tina Rosling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851347439 PECOS PAC ID: 4981666997 Enrollment ID: I20041102000494 |
| Provider Name | Michael T Montgomery |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336330232 PECOS PAC ID: 9133202047 Enrollment ID: I20080215000529 |
| Provider Name | Courtney B Mcleod |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932487113 PECOS PAC ID: 1557521192 Enrollment ID: I20120320000137 |
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