Provider Demographics
NPI:1497515225
Name:MOUNTAIN BEND MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:MOUNTAIN BEND MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFIE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:AUDLIE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-949-6300
Mailing Address - Street 1:PO BOX 1389
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-1389
Mailing Address - Country:US
Mailing Address - Phone:423-949-6300
Mailing Address - Fax:423-949-6374
Practice Address - Street 1:15166 RANKIN AVE
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-7039
Practice Address - Country:US
Practice Address - Phone:423-949-6300
Practice Address - Fax:423-949-6374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care