MEDICARE: SELECT CARE SURGICAL ASSOCIATES P C

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	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020049205	OTHER		RAILROAD MCRE
2	100010807	OTHER	TN	PHPTC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1740052	OTHER		UNITED HEALTH
5	3081453	OTHER		BCBS
6	4359544002	OTHER		CIGNA
7	282829	OTHER		ONE HEALTH

General Provider Information

NPI Number	:	1962443069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT CARE SURGICAL ASSOCIATES P C

Provider Business Mailing Address
First Line	:	460 MEDICAL PARK DR STE 106
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-5782
Country	:	US
Telephone Number	:	865-988-4452
Fax Number	:	865-988-6293

Provider Business Practice Location Address
First Line	:	460 MEDICAL PARK DRIVE
Second Line	:	SUITE 106
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-5782
Country	:	US
Telephone Number	:	865-988-4452
Fax Number	:	865-988-6293

Authorized Official
Title or Position	:	MD PRESIDENT
Name	:	MR. JOHN HENRY EASON JR.
Credential	:	MD
Telephone Number	:	865-988-4452

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	03/09/2009

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Directions to “SELECT CARE SURGICAL ASSOCIATES P C ” Practice Location

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