Provider Demographics
NPI:1962443069
Name:SELECT CARE SURGICAL ASSOCIATES P C
Entity Type:Organization
Organization Name:SELECT CARE SURGICAL ASSOCIATES P C
Other - Org Name:JOHN H EASON MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:EASON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:865-988-4452
Mailing Address - Street 1:460 MEDICAL PARK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5782
Mailing Address - Country:US
Mailing Address - Phone:865-988-4452
Mailing Address - Fax:865-988-6293
Practice Address - Street 1:460 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5782
Practice Address - Country:US
Practice Address - Phone:865-988-4452
Practice Address - Fax:865-988-6293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
020049205OtherRAILROAD MCRE
TN100010807OtherPHPTC
TN3061848Medicaid
1740052OtherUNITED HEALTH
3081453OtherBCBS
4359544002OtherCIGNA
282829OtherONE HEALTH
020049205OtherRAILROAD MCRE
TN3061848Medicare ID - Type Unspecified