MEDICARE: DR. CLAY ARLEN RENFRO MD

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	4340	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00294810	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4122287	OTHER	TN	BLUE CROSS BLUE SHIELD
3	4122287	OTHER	TN	BCBST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477520732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAY ARLEN RENFRO MD

Provider Business Mailing Address
First Line	:	219 PRINCETON ROAD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2062
Country	:	US
Telephone Number	:	423-975-2200
Fax Number	:	423-975-2210

Provider Business Practice Location Address
First Line	:	219 PRINCETON ROAD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2062
Country	:	US
Telephone Number	:	423-975-2200
Fax Number	:	423-975-2210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	10/25/2011

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