Provider Demographics
NPI:1376961979
Name:FIRST MED INC
Entity Type:Organization
Organization Name:FIRST MED INC
Other - Org Name:FIRST MED GATLINBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAUGHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-446-4032
Mailing Address - Street 1:1015 E PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GATLINBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37738-5057
Mailing Address - Country:US
Mailing Address - Phone:865-446-4032
Mailing Address - Fax:865-868-4746
Practice Address - Street 1:1015 E PARKWAY
Practice Address - Street 2:
Practice Address - City:GATLINBURG
Practice Address - State:TN
Practice Address - Zip Code:37738-5057
Practice Address - Country:US
Practice Address - Phone:865-446-4032
Practice Address - Fax:865-868-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7143950005Medicare NSC