NPIMap

Organization Active NPI

Etsu Physicians & Associates

  • Obstetrics & Gynecology Physician
  • Elizabethton, TN
National Provider Identifier
1184089559
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
ETSU PHYSICIANS & ASSOCIATES
Practice address
1505 W Elk Ave Ste 1
Elizabethton, TN 37643
Phone
(423) 543-7919
Fax
(423) 543-5323
NPI assigned
Dec 29, 2015
Last updated
Aug 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

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

Authorized official

Name
Russell Eugene Lewis
Title
Executive Director
Phone
(423) 794-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1505 W Elk Ave Ste 1
Elizabethton, TN 37643

Mailing address

1505 W Elk Ave Ste 1
Elizabethton, TN 37643-2848
Phone (423) 543-7919

Other names 1

  • Office of OB/Gyn Elizabethton Other name

National Provider Directory

National Provider Directory
Tax ID family
Dept of Path Lab-C E B27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1451347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534896000000",
    "number": "1184089559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 W ELK AVE STE 1",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432848",
            "telephone_number": "423-543-7919",
            "fax_number": "423-543-5323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W ELK AVE STE 1",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "37643",
            "telephone_number": "423-543-7919",
            "fax_number": "423-543-5323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETSU PHYSICIANS & ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-29",
        "last_updated": "2018-08-22",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "423-794-1300"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Office of OB/Gyn Elizabethton",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Office of OB/Gyn Elizabethton",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Elizabethton, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.