| Eastlake Medical, Llc | |
|
2205 Jacksboro Pike La Follette TN 37766-2904 | |
| (423) 352-6500 | |
| Not Available |
| Full Name | Eastlake Medical, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2205 Jacksboro Pike, La Follette, Tennessee |
| Authorized Official Name and Position | Paula Madron (MANAGER) |
| Authorized Official Contact | 4234949673 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastlake Medical, Llc 2500 Jacksboro Pike Suite 6 Jacksboro TN 37757 Ph: (423) 352-6500 | Eastlake Medical, Llc 2205 Jacksboro Pike La Follette TN 37766-2904 Ph: (423) 352-6500 |
| NPI Number | 1467992446 |
|---|---|
| Provider Enumeration Date | 02/24/2017 |
| Last Update Date | 06/11/2025 |
| Medicare PECOS PAC ID | 6901174788 |
|---|---|
| Medicare Enrollment ID | O20170620001620 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467992446 | NPI | - | NPPES |
| 6065731 | Other | AETNA | |
| Q028641 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (Tennessee) | Primary |
| Provider Name | Charlotte J Macdonald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922370386 PECOS PAC ID: 8224291679 Enrollment ID: I20120522000877 |
| Provider Name | Ryan A Unger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891926440 PECOS PAC ID: 8628227568 Enrollment ID: I20121009000340 |
| Provider Name | Laura Kayleigh Mundy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538520812 PECOS PAC ID: 6305138272 Enrollment ID: I20160713001671 |
| Provider Name | Raven Michelle Heatherly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417456203 PECOS PAC ID: 9931457231 Enrollment ID: I20180802001717 |
| Provider Name | Amanda Ashley Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700419090 PECOS PAC ID: 1456789452 Enrollment ID: I20200324003565 |
| Provider Name | Iesha Marlena Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023649662 PECOS PAC ID: 8123430071 Enrollment ID: I20201217000448 |
| Provider Name | Caitlyn Savage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780285932 PECOS PAC ID: 5193127876 Enrollment ID: I20210719000755 |
| Provider Name | Bailey Doepel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417575788 PECOS PAC ID: 5698166718 Enrollment ID: I20211229000037 |
| Provider Name | Kaci Lauren Henard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467111989 PECOS PAC ID: 4486039328 Enrollment ID: I20220914000250 |
| Provider Name | Christie Layne Mase |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336923432 PECOS PAC ID: 1658720503 Enrollment ID: I20231218001723 |
| Provider Name | Cory Lynn Legan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336978899 PECOS PAC ID: 6305379926 Enrollment ID: I20241104002019 |
Eastlake Medical, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2205 Jacksboro Pike, La Follette, TN 37766 Phone: 423-352-6500 Fax: 423-352-6501 | |
Mercy Cardiology Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 919 E Central Ave, Ste 102, La Follette, TN 37766 Phone: 423-907-1740 | |
Uhs Primary Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 Independence Ln Ste 200, La Follette, TN 37766 Phone: 423-562-4968 Fax: 423-562-5603 | |
East Tennessee Children's Hospital Primary Care Center, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2221 Jacksboro Pike Ste C4, La Follette, TN 37766 Phone: 423-566-3488 Fax: 866-722-3453 | |
Summit Medical Group, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2212 Jacksboro Pike, La Follette, TN 37766 Phone: 423-566-8181 Fax: 423-562-9692 | |
Visavis Health Care Medical Group Of Tn Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 136 Davis Ln, La Follette, TN 37766 Phone: 929-491-7333 | |
Wynn Habersham Community Clinic Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1037 Stinking Creek Rd, La Follette, TN 37766 Phone: 423-784-5110 |