Provider Demographics
NPI:1306846449
Name:FIRST CARE MEDICAL CENTER PC
Entity Type:Organization
Organization Name:FIRST CARE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-687-2277
Mailing Address - Street 1:108 W INSKIP DR
Mailing Address - Street 2:STE B
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-4058
Mailing Address - Country:US
Mailing Address - Phone:865-687-2277
Mailing Address - Fax:865-689-5336
Practice Address - Street 1:108 W INSKIP DR
Practice Address - Street 2:STE B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-4058
Practice Address - Country:US
Practice Address - Phone:865-687-2277
Practice Address - Fax:865-689-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN243652083X0100X
TN9319208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3719026Medicare ID - Type Unspecified
UT1283480001Medicare NSC