EAST TENNESSEE BRAIN & SPINE CENTER PC NPI 1366452914

NPI Information

  • NPI: 1366452914
  • Provider Name: EAST TENNESSEE BRAIN & SPINE CENTER, PC
  • Classification: Neurological Surgery - 207T00000X
  • Entity Type: Organization
  • Address: 701 MED TECH PKWY
    SUITE 300
    JOHNSON CITY, TN
    ZIP 37604
  • Phone: (423) 232-8301

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NPI Details

EAST TENNESSEE BRAIN & SPINE CENTER, PC is a neurological surgery in Johnson City, TN. The provider is a neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution. EAST TENNESSEE BRAIN & SPINE CENTER, PC NPI is 1366452914. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

701 MED TECH PKWY
SUITE 300
JOHNSON CITY, TN
ZIP 37604-365
Phone: (423) 232-8301
Fax: (423) 232-8304

The provider's authorized official is David A. Wiles .
The authorized official title is President and has the following contact phone number (423) 232-8301.

The enumeration date for this NPI number is 8/8/2006 and was last updated on 6/6/2012.

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
1363AS0400XPhysician AssistantSurgicalTENNESSEENo
2363LA2200XNurse PractitionerAdult HealthNo
3363LF0000XNurse PractitionerFamilyNo
4207T00000XNeurological SurgeryTENNESSEEYes

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
17100132610MEDICAIDKENTUCKY
23721061MEDICAIDTENNESSEE
33721061MEDICARE PINTENNESSEE
41366452914MEDICAIDVIRGINIA
54069221OTHERTENNESSEEBLUE CROSS/BLUE SHIELD
65903904MEDICAIDNORTH CAROLINA
7CH8343MEDICARE PINTENNESSEE
86193510001MEDICARE NSCTENNESSEE

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: 3/30/2025

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