Healthcare Provider Details

I. General information

NPI: 1689890675
Provider Name (Legal Business Name): UNICOI COUNTY MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3614 UNICOI DR
UNICOI TN
37692-6860
US

IV. Provider business mailing address

3614 UNICOI DR
UNICOI TN
37692-6860
US

V. Phone/Fax

Practice location:
  • Phone: 423-743-7151
  • Fax: 423-743-7159
Mailing address:
  • Phone: 423-743-7151
  • Fax: 423-743-7159

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: JIM S PATE
Title or Position: CHAIRMAN
Credential:
Phone: 423-743-1202