Organization Active NPI

Mountain Empire Neurological Associates PC

  • Specialist
  • Bristol, TN
National Provider Identifier
1114042629
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
MOUNTAIN EMPIRE NEUROLOGICAL ASSOCIATES PC
Practice address
3183 W State St
Suite 1201
Bristol, TN 37620-1712
Phone
(423) 761-0987
Fax
(423) 652-2512
NPI assigned
Mar 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Dr. Earl Keith Wilson, M.D.
Title
President
Phone
(423) 764-0987

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

3183 W State St
Suite 1201
Bristol, TN 37620-1712

Mailing address

3183 W State St
Suite 1201
Bristol, TN 37620-1712
Phone (423) 761-0987

National Provider Directory

National Provider Directory

Locations

105 W Stone Dr
Ste 5F
Kingsport, TN 37660
Phone (423) 764-0987

340 Bagley Cir
Marion, VA 24354
Phone (276) 783-1200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1114042629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3183 W STATE ST",
            "address_2": "SUITE 1201",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376201712",
            "telephone_number": "423-761-0987",
            "fax_number": "423-652-2512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3183 W STATE ST",
            "address_2": "SUITE 1201",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376201712",
            "telephone_number": "423-761-0987",
            "fax_number": "423-652-2512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN EMPIRE NEUROLOGICAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-764-0987",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.