Healthcare Provider Details

I. General information

NPI: 1891712782
Provider Name (Legal Business Name): MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MAIN ST
JOHNSON CITY TN
37601-4877
US

IV. Provider business mailing address

401 E MAIN ST
JOHNSON CITY TN
37601-4877
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-2584
  • Fax: 423-722-2060
Mailing address:
  • Phone: 423-929-2584
  • Fax: 423-722-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY HARDIN
Title or Position: PROVIDER RELATIONS
Credential:
Phone: 423-431-0512