Basic Information
| Provider Information | |||||||||
| NPI: | 1720083918 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOCTOR'S CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2811 W MARKET ST | ||||||||
| Address2: | STE 1 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376045127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239282135 | ||||||||
| FaxNumber: | 4239285814 | ||||||||
| Practice Location | |||||||||
| Address1: | 2811 W MARKET ST | ||||||||
| Address2: | STE 1 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376045127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239282135 | ||||||||
| FaxNumber: | 4239285814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 03/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | JEFFCOAT | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8039570500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 3713206 | 05 | TN | MEDICAID |