Provider Demographics
NPI:1376934422
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 1:1403 STATE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890-3175
Mailing Address - Country:US
Mailing Address - Phone:865-674-6603
Mailing Address - Fax:865-674-6695
Practice Address - Street 1:1403 STATE ST
Practice Address - Street 2:
Practice Address - City:WHITE PINE
Practice Address - State:TN
Practice Address - Zip Code:37890-3175
Practice Address - Country:US
Practice Address - Phone:865-674-6603
Practice Address - Fax:865-674-6695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHSTAR PHYSICIANS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty