Provider Demographics
NPI:1912194028
Name:HOLSTON REGIONAL ALTERNATIVE MEDICINE
Entity Type:Organization
Organization Name:HOLSTON REGIONAL ALTERNATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TASKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-384-9266
Mailing Address - Street 1:1303 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2444
Mailing Address - Country:US
Mailing Address - Phone:423-384-4443
Mailing Address - Fax:423-239-9649
Practice Address - Street 1:1303 E CENTER ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2444
Practice Address - Country:US
Practice Address - Phone:423-384-4443
Practice Address - Fax:423-239-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD017578261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6205721Medicaid
TN3381584Medicare PIN
VA6205721Medicaid