NPIMap

Organization Active NPI

Sr Medical Services, LLC

  • Internal Medicine Physician
  • Caryville, TN
National Provider Identifier
1679718662
Registry record updated Feb 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD42643 Issued in TN
Legal business name
SR MEDICAL SERVICES, LLC
Practice address
138 Herron LN
Caryville, TN 37714-3258
Phone
(423) 562-8339
Fax
(423) 562-8339
NPI assigned
Dec 5, 2008
Last updated
Feb 24, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2009

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

Authorized official

Name
Connie Jobe
Title
Manager
Phone
(423) 562-8339

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD42643 TN Primary

Addresses

Primary practice location

138 Herron LN
Caryville, TN 37714-3258

Mailing address

PO Box 43
Caryville, TN 37714-0043
Phone (423) 562-8339

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090211000156 TN Part B Supplier - Clinic/Group Practice 6608931498 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Harriman, TN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1228435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235433600000",
    "number": "1679718662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "city": "CARYVILLE",
            "state": "TN",
            "postal_code": "377140043",
            "telephone_number": "423-562-8339",
            "fax_number": "423-562-8339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 HERRON LN",
            "city": "CARYVILLE",
            "state": "TN",
            "postal_code": "377143258",
            "telephone_number": "423-562-8339",
            "fax_number": "423-562-8339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SR MEDICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-05",
        "last_updated": "2009-02-24",
        "status": "A",
        "authorized_official_last_name": "JOBE",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "423-562-8339"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD42643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caryville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.