| Eastlake Primary Care Llc | |
|
2500 Jacksboro Pike Ste 6 Jacksboro TN 37757-2818 | |
| (423) 352-6500 | |
| (423) 352-6501 |
| Full Name | Eastlake Primary Care Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2500 Jacksboro Pike Ste 6, Jacksboro, Tennessee |
| Authorized Official Name and Position | Valerie Lynn Miesel (OWNER) |
| Authorized Official Contact | 4233526500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastlake Primary Care Llc 2500 Jacksboro Pike Suite 6 Jacksboro TN 37757 Ph: (423) 352-6500 | Eastlake Primary Care Llc 2500 Jacksboro Pike Ste 6 Jacksboro TN 37757-2818 Ph: (423) 352-6500 |
| NPI Number | 1972043214 |
|---|---|
| Provider Enumeration Date | 03/06/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972043214 | NPI | - | NPPES |
| Q027747 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Tennessee) | Primary |
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