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General NPI Number Information
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NPI Number | 1841362555
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Entity Type | Organization
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Legal Business Name | TRI-CITY PEDIACTRIC CARDIOLOGY P C
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 04/06/2012
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Provider Practice Location Address
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Address Line | 2312 KNOB CREEK RD SUITE 208
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2367
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Country | US
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Telephone | 423-610-1099
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Fax | 423-610-1166
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Provider Business Mailing Address
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Address Line | PO BOX 3953
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City | JOHNSON CITY
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State | TN
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Zip | 37602-3953
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Country | US
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Telephone | 423-610-1099
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Fax | 423-610-1166
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. ASHOK V MEHTA
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Credential | MD
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Telephone | 423-610-1099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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