Provider Demographics
NPI:1962591982
Name:DUNLAP MEDICAL CENTER, PLLC
Entity type:Organization
Organization Name:DUNLAP MEDICAL CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:423-949-2171
Mailing Address - Street 1:PO BOX 1777
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-1777
Mailing Address - Country:US
Mailing Address - Phone:423-949-2171
Mailing Address - Fax:423-949-5118
Practice Address - Street 1:67 CATES STREET
Practice Address - Street 2:
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327-1777
Practice Address - Country:US
Practice Address - Phone:423-949-2171
Practice Address - Fax:423-949-5118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717954Medicare ID - Type UnspecifiedGROUP NUMBER