Healthcare Provider Details

I. General information

NPI: 1285986885
Provider Name (Legal Business Name): TRICITY PULMONARY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 DUNLAP RD
BLOUNTVILLE TN
37617-6333
US

IV. Provider business mailing address

PO BOX 3113
JOHNSON CITY TN
37602-3113
US

V. Phone/Fax

Practice location:
  • Phone: 423-323-7112
  • Fax: 423-323-1393
Mailing address:
  • Phone: 423-915-1126
  • Fax: 423-915-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35140
License Number StateTN

VIII. Authorized Official

Name: DR. MIRLE R GIRISH
Title or Position: MD/OWNER
Credential: M.D.
Phone: 423-612-0133