| Internal Medicine Associates Of Mcminn County Pc | |
|
301 Grady Road Etowah TN 37331-0325 | |
| (423) 263-2444 | |
| (423) 263-1553 |
| Full Name | Internal Medicine Associates Of Mcminn County Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 301 Grady Road, Etowah, Tennessee |
| Authorized Official Name and Position | Russell Brandon Watters (CEO) |
| Authorized Official Contact | 4232632444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Internal Medicine Associates Of Mcminn County Pc Po Box 325 Etowah TN 37331-0325 Ph: (423) 263-2444 | Internal Medicine Associates Of Mcminn County Pc 301 Grady Road Etowah TN 37331-0325 Ph: (423) 263-2444 |
| NPI Number | 1952367187 |
|---|---|
| Provider Enumeration Date | 04/25/2006 |
| Last Update Date | 12/14/2009 |
| Medicare PECOS PAC ID | 7113001074 |
|---|---|
| Medicare Enrollment ID | O20080301000090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952367187 | NPI | - | NPPES |
| CE0552 | Other | TN | MEDICARE RR |
| Provider Name | Samuel J Olsen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760448591 PECOS PAC ID: 1951377324 Enrollment ID: I20050627001129 |
| Provider Name | Martha Jean C Pascarella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174549638 PECOS PAC ID: 1456435700 Enrollment ID: I20080225000687 |
| Provider Name | Joel C Riley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659338044 PECOS PAC ID: 7214030477 Enrollment ID: I20100519000195 |
| Provider Name | Ghazali A Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437116720 PECOS PAC ID: 0840374708 Enrollment ID: I20100519000382 |
| Provider Name | Nathan C Trentham |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134185358 PECOS PAC ID: 8022192988 Enrollment ID: I20100520000235 |
| Provider Name | Russell B Watters |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003872201 PECOS PAC ID: 2668556523 Enrollment ID: I20100623000367 |
| Provider Name | Alicia Fulbright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902417728 PECOS PAC ID: 1456779479 Enrollment ID: I20200908002006 |
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