1376074385 NPI number — JONESBOROUGH MEDICAL CENTER

Table of content: (NPI 1376074385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376074385 NPI number — JONESBOROUGH MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JONESBOROUGH MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1376074385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 E JACKSON BLVD STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBOROUGH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37659-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-753-6077
Provider Business Mailing Address Fax Number:
423-753-8788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2811 W MARKET ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-5127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-2135
Provider Business Practice Location Address Fax Number:
423-928-5814
Provider Enumeration Date:
03/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ATYIA
Authorized Official First Name:
ATIF
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
423-753-6077

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  M30739 , 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: 3874725 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com