1285701987 NPI number — DR. JOHN HENRY EASON JR. MD

Table of content: DR. JOHN HENRY EASON JR. MD (NPI 1285701987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285701987 NPI number — DR. JOHN HENRY EASON JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EASON
Provider First Name:
JOHN
Provider Middle Name:
HENRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285701987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 MEDICAL PARK DRIVE
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
LENOIR CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37772-5782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-988-4452
Provider Business Mailing Address Fax Number:
865-988-6293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 MEDICAL PARK DR STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37772-5782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-988-4452
Provider Business Practice Location Address Fax Number:
865-988-6293
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD0000021520 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100010807 . This is a "PHP TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 62-1762205 . This is a "GROUP TAX ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1740052 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3061848 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3081453 . This is a "BLUE CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1962443069 . This is a "NPI NO FOR GROUP ONLY DOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3081453 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 020049205 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 282829 . This is a "ONE HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4359544002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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