Mountain Region Family Medicine, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MOUNTAIN REGION FAMILY MEDICINE, PC

Practice address

101 Professional Park PVT Dr
Kingsport, TN 37663-2288

Phone

(423) 239-7300

Fax

(423) 239-8581

NPI assigned

Aug 14, 2006

Last updated

Dec 14, 2017By 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

Wanda Trent

Title

Corporate Secretary

Phone

(423) 230-2109

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513209600000",
    "number": "1710990601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PROFESSIONAL PARK PVT DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632288",
            "telephone_number": "423-239-7300",
            "fax_number": "423-239-8581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PROFESSIONAL PARK PVT DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376632288",
            "telephone_number": "423-239-7300",
            "fax_number": "423-239-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN REGION FAMILY MEDICINE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2017-12-14",
        "status": "A",
        "authorized_official_last_name": "TRENT",
        "authorized_official_first_name": "WANDA",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "423-230-2109"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FBL",
            "identifier": "020189600",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3706159",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL",
            "identifier": "31378070",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mountain States Health Alliance (Indian Path Medical Center Transitional Care Unit)
• Mountain States Health Alliance (Indian Path Pavilion)
• Mountain States Health Alliance (BH Specialty Pharmacy-KPT)

• Family Medicine Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2017; 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.