Provider Demographics
NPI:1508973819
Name:MCCLINTIC, EUGENE C (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:C
Last Name:MCCLINTIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL PARK BLVD
Mailing Address - Street 2:250 WEST
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7431
Mailing Address - Country:US
Mailing Address - Phone:423-844-6620
Mailing Address - Fax:423-844-6626
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:250 WEST
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-6620
Practice Address - Fax:423-844-6626
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000024575174400000X
TN24575208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAANTHEMOther038614
TN162576OtherTN BC
TN4545327OtherAETNA
VA007345747Medicaid
TN3385580Medicaid
TN162576OtherTN BC
VA007345747Medicaid