Provider Demographics
NPI:1891110433
Name:JOHN D. SANABRIA, MD PC
Entity Type:Organization
Organization Name:JOHN D. SANABRIA, MD PC
Other - Org Name:LAKEWAY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANABRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-271-0038
Mailing Address - Street 1:460 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5782
Mailing Address - Country:US
Mailing Address - Phone:865-271-0038
Mailing Address - Fax:865-271-0040
Practice Address - Street 1:460 MEDICAL PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5782
Practice Address - Country:US
Practice Address - Phone:865-271-0038
Practice Address - Fax:865-271-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3814709Medicaid
G49967Medicare UPIN
TN3814700Medicare PIN