Healthcare Provider Details

I. General information

NPI: 1043220338
Provider Name (Legal Business Name): MOUNTAIN EMPIRE MEDICAL AND SURGICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 W ELK AVE SUITE 8
ELIZABETHTON TN
37643-2876
US

IV. Provider business mailing address

1503 W ELK AVE SUITE 8
ELIZABETHTON TN
37643-2876
US

V. Phone/Fax

Practice location:
  • Phone: 423-542-0400
  • Fax: 423-542-0201
Mailing address:
  • Phone: 423-542-0400
  • Fax: 423-542-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID S HECHT
Title or Position: PRESIDENT
Credential: MD
Phone: 423-542-0400