| Pac Of Tennessee Pc | |
|
1958 West State Street Suite 2 Bristol TN 37620-2257 | |
| (423) 573-1502 | |
| (423) 217-0604 |
| Full Name | Pac Of Tennessee Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1958 West State Street, Bristol, Tennessee |
| Authorized Official Name and Position | Kathleen Ann Holbrook (BILLING OFFICE MANAGER) |
| Authorized Official Contact | 4235731502 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pac Of Tennessee Pc 6 6th St Ste 256 Bristol TN 37620-2257 Ph: (423) 573-1502 | Pac Of Tennessee Pc 1958 West State Street Suite 2 Bristol TN 37620-2257 Ph: (423) 573-1502 |
| NPI Number | 1043856677 |
|---|---|
| Provider Enumeration Date | 11/19/2019 |
| Last Update Date | 11/19/2019 |
| Medicare PECOS PAC ID | 7517392400 |
|---|---|
| Medicare Enrollment ID | O20200123001090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043856677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Donald R Quinn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447219688 PECOS PAC ID: 1759299761 Enrollment ID: I20050323001005 |
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