Provider Demographics
NPI:1417633850
Name:LEAVE IT TO WEAVER MEDICAL
Entity Type:Organization
Organization Name:LEAVE IT TO WEAVER MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:423-839-1600
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37815-0063
Mailing Address - Country:US
Mailing Address - Phone:423-839-1600
Mailing Address - Fax:423-839-1602
Practice Address - Street 1:231 S FAIRMONT AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2036
Practice Address - Country:US
Practice Address - Phone:423-839-1600
Practice Address - Fax:423-839-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care