Provider Demographics
NPI:1063511145
Name:NORTHEAST TENNESSEE MEDICAL ASSOCIATES PLC
Entity Type:Organization
Organization Name:NORTHEAST TENNESSEE MEDICAL ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-542-5573
Mailing Address - Street 1:314 ROGOSIN DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2904
Mailing Address - Country:US
Mailing Address - Phone:423-542-5505
Mailing Address - Fax:423-542-5573
Practice Address - Street 1:314 ROGOSIN DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2904
Practice Address - Country:US
Practice Address - Phone:423-542-5505
Practice Address - Fax:423-542-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty