Rondal Keith Brock, P.A.C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

Tazewell Medical Clinic 1442 North Broad Street
Suite 7
Tazewell, TN 37879

Phone

(423) 626-6145

Fax

(423) 526-2804

NPI assigned

Nov 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tazewell Medical Clinic, Inc.

  • Clinic/Center
  • Tazewell, TN
  • NPI 1417001645
  NPD (past) Authorized official

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811075088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1037 OLD JACKSOBORO ROAD",
            "city": "CUMBERLAND GAP",
            "state": "TN",
            "postal_code": "377244444",
            "telephone_number": "423-869-9980",
            "fax_number": "423-526-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "TAZEWELL MEDICAL CLINIC 1442 NORTH BROAD STREET",
            "address_2": "SUITE 7",
            "city": "TAZEWELL",
            "state": "TN",
            "postal_code": "37879",
            "telephone_number": "423-626-6145",
            "fax_number": "423-526-2804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "RONDAL",
        "middle_name": "KEITH",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marcie L Bledsoe, CRNA
• Julia Blocker, ARNP
• Makayla Brashears, PHARMD
• Matthew A Brayton, NP
• La Wanna Wallen Brock, F.N.P., A.P.N.
• Brown Family Practice, Inc. (Calvary Medical)
• Gary W. Brown Jr., NP-C
• Beth Ann Busby-Coon, PHARM. D.
• Priscilla Cameron, FNP-C
• Robin Capps, LPTA

• Medical Physician Assistant in Tazewell, TN
• Providers in Tazewell, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.