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General NPI Number Information
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NPI Number | 1962443069
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Entity Type | Organization
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Legal Business Name | SELECT CARE SURGICAL ASSOCIATES P C
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 460 MEDICAL PARK DRIVE SUITE 106
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City | LENOIR CITY
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State | TN
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Zip | 37772-5782
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Country | US
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Telephone | 865-988-4452
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Fax | 865-988-6293
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Provider Business Mailing Address
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Address Line | 460 MEDICAL PARK DR STE 106
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City | LENOIR CITY
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State | TN
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Zip | 37772-5782
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Country | US
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Telephone | 865-988-4452
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Fax | 865-988-6293
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Authorized Official
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Title or Position | MD PRESIDENT
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Name | MR. JOHN HENRY EASON JR.
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Credential | MD
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Telephone | 865-988-4452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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