Provider Demographics
NPI:1962698696
Name:ROCKY TOP MEDICAL CENTER
Entity type:Organization
Organization Name:ROCKY TOP MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:865-908-3636
Mailing Address - Street 1:1105 OAK CLUSTER DR
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-6079
Mailing Address - Country:US
Mailing Address - Phone:865-908-3636
Mailing Address - Fax:865-908-3632
Practice Address - Street 1:1105 OAK CLUSTER DR
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-6079
Practice Address - Country:US
Practice Address - Phone:865-908-3636
Practice Address - Fax:865-908-3632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001152305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
300832100Medicare UPIN
TN3801935Medicare UPIN
3304688Medicare UPIN