Provider Demographics
NPI:1730305897
Name:MORRISTOWN FAMILY MEDICINE, P.C.
Entity Type:Organization
Organization Name:MORRISTOWN FAMILY MEDICINE, P.C.
Other - Org Name:DEBRA ANN LANE, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-581-4201
Mailing Address - Street 1:405 MCFARLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-3920
Mailing Address - Country:US
Mailing Address - Phone:423-581-4201
Mailing Address - Fax:423-581-4291
Practice Address - Street 1:405 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3920
Practice Address - Country:US
Practice Address - Phone:423-581-4201
Practice Address - Fax:423-581-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40163207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3333808Medicare ID - Type Unspecified
TNI39693Medicare UPIN