Provider Demographics
NPI:1255594487
Name:BEAN STATION FAMILY MEDICINE, PC
Entity type:Organization
Organization Name:BEAN STATION FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:865-993-1070
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-0455
Mailing Address - Country:US
Mailing Address - Phone:865-993-1070
Mailing Address - Fax:865-993-1075
Practice Address - Street 1:1179 HIGHWAY 11W
Practice Address - Street 2:
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708-5809
Practice Address - Country:US
Practice Address - Phone:865-993-1070
Practice Address - Fax:865-993-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care