Provider Demographics
NPI:1629354287
Name:BATES FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:BATES FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:BATES
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:423-472-4677
Mailing Address - Street 1:2401 N OCOEE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3853
Mailing Address - Country:US
Mailing Address - Phone:423-472-4677
Mailing Address - Fax:423-472-4620
Practice Address - Street 1:2401 N OCOEE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3853
Practice Address - Country:US
Practice Address - Phone:423-472-4677
Practice Address - Fax:423-472-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G703564Medicare PIN
H95269Medicare UPIN