Provider Demographics
NPI:1831275825
Name:LECONTE FAMILY PRACTICE, P.C.
Entity type:Organization
Organization Name:LECONTE FAMILY PRACTICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:865-453-2806
Mailing Address - Street 1:PO BOX 4310
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37864-4310
Mailing Address - Country:US
Mailing Address - Phone:865-453-2806
Mailing Address - Fax:
Practice Address - Street 1:300 PRINCE ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3823
Practice Address - Country:US
Practice Address - Phone:865-453-2806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30020261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3378953Medicaid
TN3079526OtherBLUE CROSS NUMBER
TN3079526OtherBLUE CROSS NUMBER