MOUNTAIN REGION FAMILY MEDICINE PC NPI 1710990601

NPI Information

NPI: 1710990601
Provider Name: MOUNTAIN REGION FAMILY MEDICINE, PC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 44D0951827

Address:
101 PROFESSIONAL PARK PVT DR
KINGSPORT, TN
ZIP 37663
Phone: (423) 239-7300
Get Directions

MOUNTAIN REGION FAMILY MEDICINE, PC is a family medicine in Kingsport, TN. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MOUNTAIN REGION FAMILY MEDICINE, PC NPI is 1710990601. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

101 PROFESSIONAL PARK PVT DR
KINGSPORT, TN
ZIP 37663-288
Phone: (423) 239-7300
Fax: (423) 239-8581

The provider's authorized official is Wanda Trent .
The authorized official title is Corporate Secretary and has the following contact phone number (423) 230-2109.

The CLIA number assigned to this NPI record is 44D0951827 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 8/14/2006 and was last updated on 12/14/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine			TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3706159	MEDICAID	TENNESSEE
2	020189600	OTHER	TENNESSEE	FBL
3	31378070	OTHER	TENNESSEE	DOL

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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