Healthcare Provider Details

I. General information

NPI: 1699498709
Provider Name (Legal Business Name): DHP MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 MAIN STREET
BEAN STATION TN
37708-4257
US

IV. Provider business mailing address

1034 MAIN STREET
BEAN STATION TN
37708-4257
US

V. Phone/Fax

Practice location:
  • Phone: 865-993-4047
  • Fax: 865-993-4194
Mailing address:
  • Phone: 865-993-4047
  • Fax: 865-993-4194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID KRAGEL
Title or Position: AUTHORIZED OFFICIAL/OWNER
Credential:
Phone: 865-993-4047