Provider Demographics
NPI:1164714234
Name:UNICOI COUNTY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:UNICOI COUNTY MEDICAL SERVICES, INC.
Other - Org Name:NOLICHUCKY MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-735-5700
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:423-735-5700
Mailing Address - Fax:
Practice Address - Street 1:630 ONEEGA LN
Practice Address - Street 2:SUITE A
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-2197
Practice Address - Country:US
Practice Address - Phone:423-735-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525071Medicaid
TN103G707731Medicare PIN