MEDICARE: DOCTOR'S CARE 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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720083918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTOR'S CARE INC

Provider Business Mailing Address
First Line	:	2811 W MARKET ST
Second Line	:	STE 1
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-5127
Country	:	US
Telephone Number	:	423-928-2135
Fax Number	:	423-928-5814

Provider Business Practice Location Address
First Line	:	2811 W MARKET ST
Second Line	:	STE 1
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-5127
Country	:	US
Telephone Number	:	423-928-2135
Fax Number	:	423-928-5814

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. CHRISTINA M JEFFCOAT
Credential	:
Telephone Number	:	803-957-0500

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	03/02/2016

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