MEDICARE: HOLSTON REGIONAL ALTERNATIVE MEDICINE

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	261QP2300X	Primary Care Clinic/Center	MD017578	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912194028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLSTON REGIONAL ALTERNATIVE MEDICINE

Provider Business Mailing Address
First Line	:	1303 E CENTER ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2444
Country	:	US
Telephone Number	:	423-384-4443
Fax Number	:	423-239-9649

Provider Business Practice Location Address
First Line	:	1303 E CENTER ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-2444
Country	:	US
Telephone Number	:	423-384-4443
Fax Number	:	423-239-9649

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JOHN JAMES TASKER
Credential	:	M.D.
Telephone Number	:	423-384-9266

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	01/27/2011

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