Provider Demographics
NPI:1629260963
Name:CHARLES P BOWNDS MD PC
Entity Type:Organization
Organization Name:CHARLES P BOWNDS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOWNDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-447-6833
Mailing Address - Street 1:PO BOX 349
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37367-0349
Mailing Address - Country:US
Mailing Address - Phone:423-447-6833
Mailing Address - Fax:423-447-2405
Practice Address - Street 1:120 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37367
Practice Address - Country:US
Practice Address - Phone:423-447-6833
Practice Address - Fax:423-447-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13126261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3383472Medicaid
TN3885674Medicaid
TN3383472Medicare PIN
TNB04203Medicare UPIN
TN3885674Medicaid