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NPI Code Detail

MEDICARE: STATCARE OUTPATIENT, LLC

MEDICARE: STATCARE OUTPATIENT, LLC
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
1363L00000XNurse Practitioner
2207R00000XInternal Medicine Physician
3363A00000XPhysician Assistant
4207RC0200XCritical Care Medicine (Internal Medicine) Physician
5207RS0012XSleep Medicine (Internal Medicine) Physician
6207RP1001XPulmonary Disease Physician

General Provider Information

NPI Number : 1134653892
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATCARE OUTPATIENT, LLC
Provider Business Mailing Address
First Line : PO BOX 207830
Second Line :
City : DALLAS
State : TX
Zip : 75320-4670
Country : US
Telephone Number : 888-412-2649
Fax Number : 405-384-6793
Provider Business Practice Location Address
First Line : 6473 KINGSTON PIKE STE 6473
Second Line :
City : KNOXVILLE
State : TN
Zip : 37919-4832
Country : US
Telephone Number : 888-412-2649
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JESSE T DOERS
Credential : MD
Telephone Number : 865-588-8831
Provider Enumeration Date : 04/19/2017
Last Update Date : 05/12/2026

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Directions to “STATCARE OUTPATIENT, LLC ” Practice Location

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