Provider Demographics
NPI:1649757238
Name:HEALTHSTAR PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:HEALTHSTAR PHYSICIANS, P.C.
Other - Org Name:FACULTY PHYSICIANS-LAFOLLETTE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ODESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRABSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-581-5925
Mailing Address - Street 1:2435 JACKSBORO PIKE STE 3
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2912
Mailing Address - Country:US
Mailing Address - Phone:423-449-8135
Mailing Address - Fax:423-201-9559
Practice Address - Street 1:2435 JACKSBORO PIKE STE 3
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2912
Practice Address - Country:US
Practice Address - Phone:423-449-8135
Practice Address - Fax:423-201-9559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHSTAR PHYSICIANS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-26
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM739213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty