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NPI Code Detail

MEDICARE: OVERHOME MEDICAL CARE PC

MEDICARE: OVERHOME MEDICAL CARE PC
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
1363AM0700XMedical Physician Assistant1107TN

General Provider Information

NPI Number : 1396182986
Entity Type Code : Organization
Provider Name (Legal Business Name) : OVERHOME MEDICAL CARE PC
Provider Business Mailing Address
First Line : 919 MEDICAL PARK DR
Second Line :
City : MOUNTAIN CITY
State : TN
Zip : 37683-1042
Country : US
Telephone Number : 423-727-7800
Fax Number : 423-727-2496
Provider Business Practice Location Address
First Line : 919 MEDICAL PARK DR
Second Line :
City : MOUNTAIN CITY
State : TN
Zip : 37683-1042
Country : US
Telephone Number : 423-727-7800
Fax Number : 423-727-2496
Authorized Official
Title or Position : PRESIDENT
Name : DANIEL C JONES
Credential : PA-C
Telephone Number : 423-727-7138
Provider Enumeration Date : 05/23/2013
Last Update Date : 05/23/2013

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Directions to “OVERHOME MEDICAL CARE PC ” Practice Location

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