Provider Demographics
NPI:1023288867
Name:EAST TN PHYSICIANS CARE
Entity type:Organization
Organization Name:EAST TN PHYSICIANS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCSTAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:865-525-2121
Mailing Address - Street 1:5917 RUTLEDGE PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-2252
Mailing Address - Country:US
Mailing Address - Phone:865-525-2121
Mailing Address - Fax:865-525-7892
Practice Address - Street 1:5917 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-2252
Practice Address - Country:US
Practice Address - Phone:865-525-2121
Practice Address - Fax:865-525-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3016063Medicaid
TNCH7990OtherRAILROAD MEDICARE
TN3016063Medicaid