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General NPI Number Information
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NPI Number | 1003562372
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Entity Type | Organization
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Legal Business Name | MOSHEIM RECOVERY ASSOCIATES
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 65 PAYNE RD
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City | MOSHEIM
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State | TN
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Zip | 37818-3206
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Country | US
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Telephone | 423-422-2126
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Fax | 423-422-2136
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Provider Business Mailing Address
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Address Line | 65 PAYNE RD
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City | MOSHEIM
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State | TN
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Zip | 37818-3206
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Country | US
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Telephone | 423-422-2126
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TONY YOST
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Credential | MD
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Telephone | 423-422-2126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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