Provider Demographics
NPI:1821263906
Name:ELAINE L. DEVOS MD PC
Entity Type:Organization
Organization Name:ELAINE L. DEVOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEVOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-854-9051
Mailing Address - Street 1:2817 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1900
Mailing Address - Country:US
Mailing Address - Phone:423-854-9051
Mailing Address - Fax:
Practice Address - Street 1:2511 WESLEY ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1723
Practice Address - Country:US
Practice Address - Phone:423-854-9051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28462225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3040644OtherBLUE CROSS
TN3805386Medicaid
TN3805386Medicaid