1801849674 NPI number — MARK W EMERY MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801849674 NPI number — MARK W EMERY MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

EMERY

Provider First Name:

MARK

Provider Middle Name:

W

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1801849674

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/06/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

111 W STONE DR

Provider Second Line Business Mailing Address:

SUITE 100

Provider Business Mailing Address City Name:

KINGSPORT

Provider Business Mailing Address State Name:

TN

Provider Business Mailing Address Postal Code:

37660-6027

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

423-247-5197

Provider Business Mailing Address Fax Number:

423-247-5254

Provider First Line Business Practice Location Address:

111 W STONE DR

Provider Second Line Business Practice Location Address:

SUITE 100

Provider Business Practice Location Address City Name:

KINGSPORT

Provider Business Practice Location Address State Name:

TN

Provider Business Practice Location Address Postal Code:

37660-6027

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

423-247-5197

Provider Business Practice Location Address Fax Number:

423-247-5254

Provider Enumeration Date:

05/19/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RP1001X , with the licence number:  19732 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0094319 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 65906208 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
• Identifier: 065196 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 100023382 . This is a "PHP TENN CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 1000908 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 62134825601 . This is a "JOHN DEERE HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: Z101 . This is a "UNITED HEALTHCARE OF THE RIVER VALLEY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 006040209 . This is a "VIRGINIA MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 3047487 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
• Identifier: 1736855 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 5141032 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
• Identifier: 64798580 . This is a "KENTUCKY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".