EASTLAKE MEDICAL, LLC (NPI# 1467992446) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467992446 |
| Entity Type | Organization |
| Organization Name | EASTLAKE MEDICAL, LLC |
| Other Organization Name | EASTLAKE URGENT CARE |
| Practice Address |
2500 Jacksboro Pike Ste 6 Jacksboro TN 37757-2818 |
| Mailing Address |
2500 Jacksboro Pike Suite 6 Jacksboro TN 37757 |
| Practice Telephone | 4233526500 |
| Practice Fax Number | 4233526501 |
| Mailing Telephone | 4233526500 |
| Mailing Fax Number | 4233526501 |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2019-06-27 |
| Authorized Official Name | VALERIE LYNN MIESEL (OWNER) |
| Authorized Official Telephone | 4233526500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
TN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AETNA | 6065731 | 01 | |
| TN | Q028641 | 05 |
| Other Name | Type Code |
|---|---|
| Eastlake Urgent Care | Doing Business As Name - Organization |
| Street Address |
2500 JACKSBORO PIKE STE 6 |
| City | JACKSBORO |
| State | TN |
| Zip Code | 37757-2818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538520812 | Laura Kaleigh Mundy | Nurse Practitioner | 2500 Jacksboro Pike Ste 6, Jacksboro, TN 37757-2818 | 2016-03-14 |
| 1700419090 | Amanda Ashley Thomas | Nurse Practitioner | 2500 Jacksboro Pike Ste 6, Jacksboro, TN 37757-2818 | 2020-02-15 |
| 1972043214 | Eastlake Primary Care LLC | Clinic/Center | 2500 Jacksboro Pike Ste 6, Jacksboro, TN 37757-2818 | 2017-03-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861809642 | Samantha Ross | Physical Therapy Assistant | 272 Gardner Lane, Jacksboro, TN 37757 | 2014-07-14 |
| 1225348493 | Summit Medical Group, Pllc | Internal Medicine | 163 Perkins Lane, Jacksboro, TN 37757 | 2010-10-20 |
| 1518112911 | Pediatric Professionals | Specialist | 136 Mountain Perkins Lane, Suite 2, Jacksboro, TN 37757 | 2008-11-26 |
| 1992804827 | Riggs Drug Store | Pharmacy | 2636 Jacksboro Pike, Jacksboro, TN 37757 | 2006-09-21 |
| 1629536362 | Jacksboro Urgent Care | Clinic/Center | 2707 Jacksboro Pike, Suite 2, Jacksboro, TN 37757 | 2019-03-12 |
| 1942598305 | Thomas Wayne Robbins | Family Medicine | 2545 Jacksboro Pike, Jacksboro, TN 37757 | 2011-07-19 |
| 1841514155 | Margaret Reid Young | Nurse Practitioner | 136 Mountain Perkins Lane, Suite 2, Jacksboro, TN 37757 | 2010-03-16 |
| 1962540880 | State of Tennessee | Public Health or Welfare | 162 Sharp Perkins Road, Jacksboro, TN 37757 | 2007-02-02 |
| 1083868517 | Med-trans Corporation | Ambulance | 588 Memorial Lane, Jacksboro, TN 37757-0000 | 2008-11-11 |
| 1780722975 | Wanda F Tackett | Registered Nurse | 162 Sharp Perkins Road, Jacksboro, TN 37757-0418 | 2007-02-01 |
| Find all providers in zip 37757 | ||||
| Taxonomy Code | 261QU0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Urgent Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629536362 | Jacksboro Urgent Care | Clinic/Center | 2707 Jacksboro Pike, Suite 2, Jacksboro, TN 37757 | 2019-03-12 |
| 1538571716 | Velocity Medical, LLC | Clinic/Center | 2702 Jacksboro Pike, Jacksboro, TN 37757-4850 | 2014-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134749906 | Three Rivers Medical | Clinic/Center | 2725 E Governor John Sevier Hwy, Knoxville, TN 37914-6620 | 2020-04-22 |
| 1487273702 | Sanitas Medical Center of Tennessee PC | Clinic/Center | 1632 Memorial Blvd Ste 1646, Murfreesboro, TN 37129-2104 | 2020-04-16 |
| 1154980639 | Zup Medical Services, LLC | Clinic/Center | 4576 Poplar Avenue, Memphis, TN 38117 | 2019-06-10 |
| 1194380568 | Advanced Urgent Care Pllc | Clinic/Center | 455 N Chancery St Ste A, Mcminnville, TN 37110-2049 | 2019-05-01 |
| 1295208874 | Lwc Sevice Providers LLP | Clinic/Center | 111 Ellison Rd Ste 2, La Follette, TN 37766-3025 | 2019-01-07 |
| 1639655368 | Bunker Hill Staffing Urgent Care LLC | Clinic/Center | 1300 Bunker Hill Rd Ste B, Cookeville, TN 38506 | 2018-07-16 |
| 1386159523 | Wellmont Medical Associates, Inc. | Clinic/Center | 1021 Coolidge St Ste 4, Greeneville, TN 37743-5986 | 2017-12-11 |
| 1245754043 | Green River Medical Clinic, LLC | Clinic/Center | 315 Robert Rose Dr Ste F, Murfreesboro, TN 37129-6361 | 2017-08-02 |
| 1235669680 | Uhs Ventures | Clinic/Center | 1130 Middle Creek Rd Ste 290, Sevierville, TN 37862-3051 | 2017-06-19 |
| 1477087658 | Urgent Care Enterprise LLC | Clinic/Center | 5304 Cane Ridge Rd, Antioch, TN 37013-3839 | 2017-04-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.