Provider Demographics
NPI:1205226032
Name:HEALTHSTAR PHYSICIANS, PC
Entity Type:Organization
Organization Name:HEALTHSTAR PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-581-5925
Mailing Address - Street 1:657 E BROADWAY BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-4948
Mailing Address - Country:US
Mailing Address - Phone:865-475-9062
Mailing Address - Fax:865-475-9063
Practice Address - Street 1:657 E BROADWAY BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-4948
Practice Address - Country:US
Practice Address - Phone:865-475-9062
Practice Address - Fax:865-475-9063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHSTAR PHYSICIANS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty