Provider Demographics
NPI:1952680043
Name:PRESTON MICHAEL
Entity Type:Organization
Organization Name:PRESTON MICHAEL
Other - Org Name:DBA MEDDIRECT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-203-4528
Mailing Address - Street 1:6719 MAYNARDVILLE PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-5348
Mailing Address - Country:US
Mailing Address - Phone:865-203-4528
Mailing Address - Fax:
Practice Address - Street 1:10404 JACKSON OAKS WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3293
Practice Address - Country:US
Practice Address - Phone:865-223-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care