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1901 S Shady St Mountain City TN 37683-2021 | |
(423) 727-1103 | |
(423) 727-1140 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1901 S Shady St, Mountain City, Tennessee |
Authorized Official Name and Position | Shane Edwin Hilton (EVP/CFO) |
Authorized Official Contact | 4233023467 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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311 Princeton Rd Ste 1 Johnson City TN 37601-2026 Ph: (423) 727-1103 | 1901 S Shady St Mountain City TN 37683-2021 Ph: (423) 727-1103 |
NPI Number | 1518079532 |
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Provider Enumeration Date | 08/31/2006 |
Last Update Date | 04/16/2024 |
Medicare PECOS PAC ID | 6002726718 |
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Medicare Enrollment ID | O20030507000035 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518079532 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 0000000038 (Tennessee) | 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 | |