| |
222 Oak St Mountain City TN 37683-1526 | |
(423) 727-6319 | |
(423) 727-4164 |
Full Name | |
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Speciality | Clinic/Center |
Location | 222 Oak St, Mountain City, Tennessee |
Authorized Official Name and Position | Linda W Buck (CEO) |
Authorized Official Contact | 4232729163 |
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 850 Rogersville TN 37857-0850 Ph: (423) 272-9163 | 222 Oak St Mountain City TN 37683-1526 Ph: (423) 727-6319 |
NPI Number | 1720088537 |
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Provider Enumeration Date | 07/22/2005 |
Last Update Date | 10/10/2008 |
Medicare PECOS PAC ID | 0941118111 |
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Medicare Enrollment ID | O20040505000964 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720088537 | NPI | - | NPPES |
4122525 | Other | TN | BLUECROSS BLUESHIELD |
3703867 | Other | CIGNA/MEDICARE | |
4448155 | Medicaid | TN | |
004 | Other | CHAMPUS PROVIDER | |
020845900 | Other | BLACKLUNG |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Donald F Tarr Md Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4200 Cold Springs Rd, Mountain City, TN 37683 Phone: 423-727-7743 Fax: 423-727-5509 | |
Donald R Walters Mdpc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 212 N Church St, Mountain City, TN 37683 Phone: 423-727-7711 Fax: 423-727-0209 | |