Bishofberger Medical Associates of East Tennessee

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

41757 Issued in TN

Legal business name

BISHOFBERGER MEDICAL ASSOCIATES OF EAST TENNESSEE

Practice address

188 Hospital LN
Jellico, TN 37762-4400

Phone

(423) 784-1300

Fax

(423) 784-1420

NPI assigned

Mar 24, 2008

Last updated

Dec 1, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas E Bishofberger, MD

Title

Owner

Phone

(423) 784-1300

Specialties & licenses 2

Addresses

Other identifiers 6

Locations

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

{
    "created_epoch": "1206316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322697600000",
    "number": "1649442237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1381 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860013",
            "telephone_number": "317-216-2528",
            "fax_number": "317-216-2894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "188 HOSPITAL LN",
            "city": "JELLICO",
            "state": "TN",
            "postal_code": "377624400",
            "telephone_number": "423-784-1300",
            "fax_number": "423-784-1420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BISHOFBERGER MEDICAL ASSOCIATES OF EAST TENNESSEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-24",
        "last_updated": "2011-12-01",
        "status": "A",
        "authorized_official_last_name": "BISHOFBERGER",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-784-1300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "TN",
            "license": "41757",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "41757",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD OF TENN",
            "identifier": "4177360",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER -GROUP MEMBER PTAN",
            "identifier": "P00817876",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER -GROUP MEMBER NPI",
            "identifier": "1174681639",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN LICENSURE",
            "identifier": "41757",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER -GROUP PTAN",
            "identifier": "DQ1434",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER -GROUP NPI",
            "identifier": "1649442237",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Jellico, TN
• Providers in Jellico, TN by specialty
• Medical Specialty Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; 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.