| East Tennessee State University | |
|
2151 Century Lane Johnson City TN 37604 | |
| (423) 926-2500 | |
| (423) 926-5999 |
| Full Name | East Tennessee State University |
|---|---|
| Speciality | Clinic/Center |
| Location | 2151 Century Lane, Johnson City, Tennessee |
| Authorized Official Name and Position | Betty J King (SENIOR ASSOCIATE VICE PRESIDENT F&A) |
| Authorized Official Contact | 4234394414 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| 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 2151 Century Lane Johnson City TN 37604 Ph: (423) 926-2500 |
| NPI Number | 1477660199 |
|---|---|
| Provider Enumeration Date | 08/25/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 2769394774 |
|---|---|
| Medicare Enrollment ID | O20100813000904 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477660199 | NPI | - | NPPES |
| 0441901 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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 | |
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 | |
State Of Franklin Healthcare Associates Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2528 Wesley St, Suite 2, Johnson City, TN 37601 Phone: 423-794-2430 Fax: 423-283-9719 |