| Ut Primary Care Heartland | |
|
309 N Broad St New Tazewell TN 37825-6600 | |
| (423) 626-7297 | |
| (423) 626-1144 |
| Full Name | Ut Primary Care Heartland |
|---|---|
| Speciality | Clinic/Center |
| Location | 309 N Broad St, New Tazewell, Tennessee |
| Authorized Official Name and Position | Beth A. Maynard (VICE PRESIDENT) |
| Authorized Official Contact | 8653056427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ut Primary Care Heartland Po Box 415000-msc8180 Nashville TN 37241-8180 Ph: (423) 626-7297 | Ut Primary Care Heartland 309 N Broad St New Tazewell TN 37825-6600 Ph: (423) 626-7297 |
| NPI Number | 1215399654 |
|---|---|
| Provider Enumeration Date | 03/24/2016 |
| Last Update Date | 01/20/2023 |
| Medicare PECOS PAC ID | 6002727187 |
|---|---|
| Medicare Enrollment ID | O20081106000733 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215399654 | NPI | - | NPPES |
| Q024259 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Tennessee) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (Tennessee) | Primary |
| Provider Name | Luis C Pannocchia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912988965 PECOS PAC ID: 3072609809 Enrollment ID: I20071224000019 |
| Provider Name | Charles H. Debusk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780665745 PECOS PAC ID: 5890881627 Enrollment ID: I20101011000881 |
| Provider Name | Angela Dawn Thornsbury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710427190 PECOS PAC ID: 0244516433 Enrollment ID: I20170425001199 |
Heartland Medical, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 309 N Broad St, New Tazewell, TN 37825 Phone: 423-626-7297 Fax: 423-626-5553 | |
Fast Pace Medical Clinic Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 402 S Broad St, New Tazewell, TN 37825 Phone: 423-919-8244 Fax: 423-919-8245 | |
Elite Family Care, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 606 N Broad St, New Tazewell, TN 37825 Phone: 423-626-0466 | |
Heartland Medical P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 309 N Broad St, New Tazewell, TN 37825 Phone: 423-626-7297 Fax: 423-851-4704 |