Provider Demographics
NPI:1689890675
Name:UNICOI COUNTY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:UNICOI COUNTY MEDICAL SERVICES INC
Other - Org Name:DBA UNICOI VALLEY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-743-1202
Mailing Address - Street 1:3614 UNICOI DR
Mailing Address - Street 2:
Mailing Address - City:UNICOI
Mailing Address - State:TN
Mailing Address - Zip Code:37692-6860
Mailing Address - Country:US
Mailing Address - Phone:423-743-7151
Mailing Address - Fax:423-743-7159
Practice Address - Street 1:3614 UNICOI DR
Practice Address - Street 2:
Practice Address - City:UNICOI
Practice Address - State:TN
Practice Address - Zip Code:37692-6860
Practice Address - Country:US
Practice Address - Phone:423-743-7151
Practice Address - Fax:423-743-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty