Provider Demographics
NPI:1114136546
Name:JOSEPH E. BIEBERLY, MD
Entity Type:Organization
Organization Name:JOSEPH E. BIEBERLY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIEBERLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-854-0001
Mailing Address - Street 1:630 ONEEGA LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-2197
Mailing Address - Country:US
Mailing Address - Phone:423-854-0001
Mailing Address - Fax:423-854-0002
Practice Address - Street 1:3101 BROWNS MILL RD PMB 386
Practice Address - Street 2:SUITE 6
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4100
Practice Address - Country:US
Practice Address - Phone:423-854-0001
Practice Address - Fax:423-854-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12505173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3182898Medicaid
TN3182898Medicaid
TNB04048Medicare UPIN