NPIMap

Organization Active NPI

Mobile Occ Med and Wellness, PLLC

Doing business as Emmaus Medical and Counseling

  • Community/Behavioral Health Agency
  • Bulls Gap, TN
National Provider Identifier
1104327360
Registry record updated Feb 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MOBILE OCC MED AND WELLNESS, PLLC
Doing business as
Emmaus Medical and Counseling
Practice address
273 Highway 11 E
Bulls Gap, TN 37711-3433
Phone
(423) 676-8400
Fax
(423) 393-4344
NPI assigned
Feb 23, 2018
Last updated
Feb 23, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Charles L Backus III, DONPI 1801856414
Title
Medical Director
Phone
(423) 676-8400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

273 Highway 11 E
Bulls Gap, TN 37711-3433

Mailing address

273 Highway 11 E
Bulls Gap, TN 37711-3433
Phone (423) 676-8400

Other names 1

  • Emmaus Medical and Counseling Doing business as

National Provider Directory

National Provider Directory

Locations

273 Highway 11 E
Bulls Gap, TN 37711
Phone (423) 393-4146

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519344000000",
    "number": "1104327360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "273 HIGHWAY 11 E",
            "city": "BULLS GAP",
            "state": "TN",
            "postal_code": "377113433",
            "telephone_number": "423-676-8400",
            "fax_number": "423-393-4377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "273 HIGHWAY 11 E",
            "city": "BULLS GAP",
            "state": "TN",
            "postal_code": "377113433",
            "telephone_number": "423-676-8400",
            "fax_number": "423-393-4344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE OCC MED AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-23",
        "last_updated": "2018-02-23",
        "status": "A",
        "authorized_official_last_name": "BACKUS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "423-676-8400",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emmaus Medical and Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bulls Gap, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.