MEDICARE: DR. JOHN MCELLIGOTT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QX0100X	Occupational Medicine Clinic/Center	019916	TN
2	207P00000X	Emergency Medicine Physician	MD19916	TN

General Provider Information

NPI Number	:	1477608214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MCELLIGOTT MD

Provider Business Mailing Address
First Line	:	2377 PAULY BROOK WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37932-3738
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9135 MIDDLEBROOK PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-1425
Country	:	US
Telephone Number	:	865-558-3038
Fax Number	:	865-558-3515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	02/18/2010

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