Provider Demographics
NPI:1518171040
Name:SEQUATCHIE VALLEY PRIMARY CARE
Entity Type:Organization
Organization Name:SEQUATCHIE VALLEY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-942-9171
Mailing Address - Street 1:24 MOUNTAIN VIEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:KIMBALL
Mailing Address - State:TN
Mailing Address - Zip Code:37347-5477
Mailing Address - Country:US
Mailing Address - Phone:423-942-9171
Mailing Address - Fax:423-942-9128
Practice Address - Street 1:24 MOUNTAIN VIEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:KIMBALL
Practice Address - State:TN
Practice Address - Zip Code:37347-5477
Practice Address - Country:US
Practice Address - Phone:423-942-9171
Practice Address - Fax:423-942-9128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1526744Medicaid
TN1526744Medicaid