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General NPI Number Information
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NPI Number | 1134003551
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Entity Type | Organization
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Legal Business Name | EAST TN MEDICAL CLINIC
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 1145 W LEXINGTON AVE STE C
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City | WINCHESTER
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State | KY
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Zip | 40391-1290
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Country | US
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Telephone | 423-419-5049
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Fax | 423-973-3574
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Provider Business Mailing Address
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Address Line | 1145 W LEXINGTON AVE STE C
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City | WINCHESTER
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State | KY
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Zip | 40391-1290
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Country | US
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Telephone | 423-419-5049
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Fax | 423-973-3574
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Authorized Official
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Title or Position | PARTNER/OWNER
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Name | TIFFANY OSBORNE
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Credential |
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Telephone | 423-419-5049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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