Provider Demographics
NPI:1952719601
Name:FIRST MED INC
Entity Type:Organization
Organization Name:FIRST MED INC
Other - Org Name:FIRST MED KINGSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAUGHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-446-4032
Mailing Address - Street 1:1229 N EASTMAN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3166
Mailing Address - Country:US
Mailing Address - Phone:423-765-2243
Mailing Address - Fax:423-765-2245
Practice Address - Street 1:190 COMMUNITY CENTER DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-6251
Practice Address - Country:US
Practice Address - Phone:865-446-4032
Practice Address - Fax:865-868-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD16795261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3023149Medicaid
TN3023149Medicaid