Healthcare Provider Details

I. General information

NPI: 1851538417
Provider Name (Legal Business Name): SOUTHERN TENNESSEE INTERNAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2009
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1383 S COLLEGE ST
WINCHESTER TN
37398-2414
US

IV. Provider business mailing address

PO BOX 705
WINCHESTER TN
37398-0705
US

V. Phone/Fax

Practice location:
  • Phone: 931-962-3500
  • Fax: 931-962-3545
Mailing address:
  • Phone: 931-962-3500
  • Fax: 931-962-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number44409
License Number StateTN

VIII. Authorized Official

Name: DR. JEFF HUAQING YE
Title or Position: CHIEF MANAGER
Credential: M.D.
Phone: 931-962-3500