Michael Wall, Pc | |
362 High St Maryville TN 37804-5835 | |
(865) 413-1589 | |
(865) 205-9475 |
Full Name | Michael Wall, Pc |
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Speciality | Clinic/Center |
Location | 362 High St, Maryville, Tennessee |
Authorized Official Name and Position | Michael Wall (OWNER) |
Authorized Official Contact | 8659954643 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Michael Wall, Pc Po Box 5777 Maryville TN 37802-5777 Ph: (865) 246-2104 | Michael Wall, Pc 362 High St Maryville TN 37804-5835 Ph: (865) 413-1589 |
NPI Number | 1023727633 |
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Provider Enumeration Date | 11/22/2022 |
Last Update Date | 11/22/2022 |
Medicare PECOS PAC ID | 3870963952 |
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Medicare Enrollment ID | O20230106000141 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023727633 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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