MEDICARE: MCC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		TN

General Provider Information

NPI Number	:	1003935321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCC, INC.

Provider Business Mailing Address
First Line	:	501 E WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4038
Country	:	US
Telephone Number	:	423-722-8446
Fax Number	:	423-722-5674

Provider Business Practice Location Address
First Line	:	501 E WATAUGA AVE
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-4038
Country	:	US
Telephone Number	:	423-722-8446
Fax Number	:	423-722-5674

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL N. DUBE
Credential	:	MD
Telephone Number	:	423-722-4000

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/22/2020

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