Provider Demographics
NPI:1023058179
Name:POPP, RICK A
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:A
Last Name:POPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 HIGHWAY 411 N
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-1912
Mailing Address - Country:US
Mailing Address - Phone:423-263-3600
Mailing Address - Fax:
Practice Address - Street 1:886 HIGHWAY 411 N
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1912
Practice Address - Country:US
Practice Address - Phone:423-263-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23815207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00643331OtherRAILROAD MEDICARE
TN1506780Medicaid
TN4185154OtherBCBS OF TN
TN30722511Medicare PIN