Provider Demographics
NPI:1134473655
Name:EAST TN FAMILY CARE LLC
Entity Type:Organization
Organization Name:EAST TN FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICKEY
Authorized Official - Last Name:MAUGHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-429-0208
Mailing Address - Street 1:PO BOX 1518
Mailing Address - Street 2:
Mailing Address - City:PIGEON FORGE
Mailing Address - State:TN
Mailing Address - Zip Code:37868-1518
Mailing Address - Country:US
Mailing Address - Phone:865-429-0208
Mailing Address - Fax:865-429-0202
Practice Address - Street 1:1548 PARKWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-4019
Practice Address - Country:US
Practice Address - Phone:865-429-0208
Practice Address - Fax:865-429-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16795261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care