| Constantino Diaz Miranda, MD | |
|
435 2nd Street, Newport, TN 37821-3703 | |
| (423) 625-2200 | |
| Not Available |
| Full Name | Constantino Diaz Miranda |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 435 2nd Street, Newport, Tennessee |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093782963 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | TN021298 (Tennessee) | Primary |
| Entity Name | Southeastern Emergency Physicians Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356379382 PECOS PAC ID: 2466364997 Enrollment ID: O20050125000997 |
| Entity Name | Emergency Coverage Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427005008 PECOS PAC ID: 3072412592 Enrollment ID: O20050207000666 |
| Entity Name | Wellmont Medical Associates Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1780986257 PECOS PAC ID: 8123291739 Enrollment ID: O20111026000909 |
| Entity Name | App Of Tennessee Ed Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1003230236 PECOS PAC ID: 8123251766 Enrollment ID: O20140506000159 |
| Entity Name | Tri-cities Regional Emergency Physicians, Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1063950046 PECOS PAC ID: 3678859477 Enrollment ID: O20170410002399 |
| Mailing Address | Practice Location Address |
|---|---|
| Constantino Diaz Miranda, MD Po Box 30707, Knoxville, TN 37930-0707 Ph: () - | Constantino Diaz Miranda, MD 435 2nd Street, Newport, TN 37821-3703 Ph: (423) 625-2200 |
Travis Fawver, DO Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 435 2nd St, Newport, TN 37821 Phone: 423-625-2200 | |
Dr. Wayne Berry Iii, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 407 4th St, Newport, TN 37821 Phone: 423-623-6240 Fax: 423-623-0102 | |
David L Shumway, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 435 2nd St, Newport, TN 37821 Phone: 800-577-7707 Fax: 865-769-3476 |