| East Tennessee State University | |
|
365 Stout Drive Nicks Hall Rm 160 Johnson City TN 37614-6500 | |
| (423) 439-4225 | |
| (423) 439-4560 |
| Full Name | East Tennessee State University |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 365 Stout Drive, Johnson City, Tennessee |
| Authorized Official Name and Position | Betty J King (ACTING CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 4234394414 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| East Tennessee State University 365 Stout Drive Box 70403 Johnson City TN 37614-1703 Ph: (423) 439-4515 | East Tennessee State University 365 Stout Drive Nicks Hall Rm 160 Johnson City TN 37614-6500 Ph: (423) 439-4225 |
| NPI Number | 1568570273 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 09/22/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568570273 | NPI | - | NPPES |
| 3709292 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Secondary |
Mcc, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 501 E Watauga Ave, Johnson City, TN 37601 Phone: 423-722-8446 Fax: 423-722-5674 | |
Medical Education Assistance Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 917 W Walnut St, Johnson City, TN 37604 Phone: 423-439-6464 Fax: 423-439-7118 | |
Wyche & Wyche, M.d., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2406 Susannah St, Johnson City, TN 37601 Phone: 423-282-2542 Fax: 423-282-5447 | |
Imperial Healthcare Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1604 Lamons Ln Ste 230, Johnson City, TN 37604 Phone: 423-930-5168 Fax: 423-328-0193 | |
Blue Ridge Medical Management Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 410 N State Of Franklin Rd, Suite 135b, Johnson City, TN 37604 Phone: 423-431-4866 Fax: 423-431-2372 | |
New Life Chiropractic And Wellness Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 514 E Watauga Ave, Johnson City, TN 37601 Phone: 423-928-4101 | |
Blue Ridge Medical Management Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 310 N State Of Franklin Rd, Ste 301a, Johnson City, TN 37604 Phone: 423-431-6816 Fax: 423-431-2983 |