Provider Demographics
NPI:1285916791
Name:NORTHEAST TENNESSEE EMERGENCY PHYSICIANS PC
Entity type:Organization
Organization Name:NORTHEAST TENNESSEE EMERGENCY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-946-9791
Mailing Address - Street 1:PO BOX 11827
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-1827
Mailing Address - Country:US
Mailing Address - Phone:888-311-8760
Mailing Address - Fax:386-274-7891
Practice Address - Street 1:127 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2853
Practice Address - Country:US
Practice Address - Phone:276-546-7440
Practice Address - Fax:386-274-7891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty