Provider Demographics
NPI:1518902378
Name:FIRST MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:FIRST MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-543-1261
Mailing Address - Street 1:1505 W ELK AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2848
Mailing Address - Country:US
Mailing Address - Phone:423-543-1261
Mailing Address - Fax:423-543-7500
Practice Address - Street 1:1505 W ELK AVE
Practice Address - Street 2:STE 2
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2848
Practice Address - Country:US
Practice Address - Phone:423-543-1261
Practice Address - Fax:423-543-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000007688302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3095880OtherTODD A WHITAKER
TN3049825OtherCHRISTOPHER CHRISOHON
TN202731OtherDAVID K. FENNER
TN201576OtherROBERT E. WALTER
TN201575OtherJERRY L. GASTINEAU
TNQ42272Medicare UPIN
TNG70950Medicare UPIN
NE3640092Medicare ID - Type UnspecifiedTRACY M. LUTHER
TN3152036Medicare ID - Type UnspecifiedJERRY L. GASTINEAU
TNBO3687Medicare UPIN
TNBO2385Medicare UPIN
TN201575OtherJERRY L. GASTINEAU
TNPO2889Medicare UPIN
TN3669545Medicare ID - Type UnspecifiedCHRISTOPHER CHRISOHON
TN3195329Medicare ID - Type UnspecifiedROBERT E. WALTER
TN3095880OtherTODD A WHITAKER
TN3175303Medicare ID - Type UnspecifiedDAVID K. FENNER