NPIMap

Organization Active NPI

Unicoi County Family Practice

  • Primary Care Clinic/Center
  • Erwin, TN
National Provider Identifier
1407940067
Registry record updated Jul 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
25069 Issued in TN
Legal business name
UNICOI COUNTY FAMILY PRACTICE
Practice address
108 Gay Street
Erwin, TN 37650
Phone
(423) 743-8400
Fax
(423) 743-6888
NPI assigned
Oct 3, 2006
Last updated
Jul 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2008

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

Authorized official

Name
Dr. Diane Cole Campbell, M.D.
Title
President of Corporation
Phone
(423) 743-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 25069 TN Primary

Addresses

Primary practice location

108 Gay Street
Erwin, TN 37650

Mailing address

P.O. Box 759
Erwin, TN 37650-0759
Phone (423) 743-8400

Other identifiers 1

IdentifierTypeStateIssuer
4004557MedicaidTN

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1407940067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 759",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "376500759",
            "telephone_number": "423-743-8400",
            "fax_number": "423-743-6888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 GAY STREET",
            "city": "ERWIN",
            "state": "TN",
            "postal_code": "37650",
            "telephone_number": "423-743-8400",
            "fax_number": "423-743-6888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNICOI COUNTY FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "COLE",
        "authorized_official_title_or_position": "PRESIDENT OF CORPORATION",
        "authorized_official_telephone_number": "423-743-8400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "25069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4004557",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erwin, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.