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General NPI Number Information
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NPI Number | 1417031071
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Entity Type | Organization
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Legal Business Name | SMOKIE MOUNTAIN DIALYSIS INC.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 101 MED TECH PKWY SUITE 406
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4007
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Country | US
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Telephone | 423-232-8882
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4087
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City | JOHNSON CITY
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State | TN
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Zip | 37602-4087
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | STANLEY EUGENE VERMILLION
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Credential | M.D.
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Telephone | 423-232-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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