DR. PAUL THOMAS PROVANCE (NPI# 1760429740) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760429740 |
| Entity Type | Individual |
| Full Name | DR. PAUL THOMAS PROVANCE |
| Credential | M.D. |
| Practice Address |
James H Quillen Va Medical Center Mountain Home TN 37684-4000 |
| Mailing Address |
Po Box 4000 Mountain Home TN 37684-4000 |
| Practice Telephone | 4239261171 |
| Mailing Telephone | 4239261171 |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2010-11-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | MD41434 | TN | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | 35.086268 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2571293 | 05 | |
| TN | 3825653 | 05 |
| Street Address |
JAMES H QUILLEN VA MEDICAL CENTER |
| City | MOUNTAIN HOME |
| State | TN |
| Zip Code | 37684-4000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063668010 | Danny Icenhour | Pharmacist | James H Quillen Va Medical Center, Mountain Home, TN 37684 | 2008-08-11 |
| 1700045457 | Jacqueline Kracker | Psychologist | James H Quillen Va Medical Center, Psychology Service, Mountain Home, TN 37684 | 2008-06-07 |
| 1033132774 | Charles William Schutter II | Physical Therapist | James H Quillen Va Medical Center, 4000, Mountain Home, TN 37684 | 2006-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235730524 | Kendra Lee Thorne | Psychologist | Corner of Lamont St and Veterans Way, Building 160, Mountain Home, TN 37684 | 2020-11-04 |
| 1255930160 | Maximillian Scott Crockett | Optometrist | James. H Quillen Vamc, Eye Clinic 112e, Mountain Home, TN 37684 | 2020-10-21 |
| 1699393256 | Joshua Thomas Spencer | Pharmacist | Veterans Way and Lamont St, Mountain Home, TN 37684 | 2020-07-10 |
| 1073140265 | James Hankil Kim | Student in an Organized Health Care Education/Training Program | Building 52/lake Drive, Mountain Home, TN 37684 | 2020-03-26 |
| 1932736030 | Trishna Sharma | Student in an Organized Health Care Education/Training Program | Building 52/lake Drive Mountain Home, Johnson City, TN 37684 | 2020-03-26 |
| 1508421884 | Sarvatit Patel | Student in an Organized Health Care Education/Training Program | 52 Lake Dr, Mountain Home, TN 37684 | 2019-05-02 |
| 1902366024 | Katelyn Cserjes | Student in an Organized Health Care Education/Training Program | Building 52 Lake Drive Va Medical Center, Mountain Home, TN 37684 | 2019-03-24 |
| 1114404282 | Anesa Ellen Hughes | Pharmacist | Veterans Way and Lamont St Mountain Home, Mountain Home, TN 37684 | 2018-07-23 |
| 1508352287 | Leon Nguyen | Optometrist | James H. Quillen Vamc - Lamont St & Veterans Way, Eye Clinic 112e, Mountain Home, TN 37684 | 2018-07-06 |
| 1649761750 | Bahaaeldin Ibrahim Mahmoud Youssef | Student in an Organized Health Care Education/Training Program | Va Building 1 Carl A Jones Hall, Dogwood Avenue, Mountain Home, TN 37684 | 2018-05-24 |
| Find all providers in zip 37684 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497924047 | Barbara Tan King Overbay | Internal Medicine | Vamc 11-pc, Primary Care Clinic, Mountain Home, TN 37684 | 2008-02-28 |
| 1689898843 | Grant Mathews | Internal Medicine | 555 West 6th St, Mountain Home, AR 72653-3207 | 2007-04-12 |
| 1073692166 | Krzysztof Hendryk Ziola | Internal Medicine | 2280 American Legion Blvd., Mountain Home, ID 83647 | 2006-11-02 |
| 1952482440 | Michael Peter Koelsch | Internal Medicine | 805 North 6th East, Mountain Home, ID 83647 | 2006-10-18 |
| 1073600011 | William Dralle | Internal Medicine | Corner of Lamont and Sidney Streets, Mountain Home, TN 37684 | 2006-10-10 |
| 1821009473 | Carol Procter | Internal Medicine | Corner of Lamont and Sidney, Mountain Home, TN 37684 | 2006-08-10 |
| 1407888571 | Jonathan Lee Pollitte | Internal Medicine | James H Quillen Veterans Affairs Medical Center, Sydney and Lamont Street, Mountain Home, TN 37684 | 2006-07-07 |
| 1013961994 | James C Croom | Internal Medicine | 230 Highway 5 N Ste 20, Mountain Home, AR 72653-3031 | 2006-05-22 |
| 1649236290 | Lance R Lincoln | Internal Medicine | 405 Buttercup Dr, Mountain Home, AR 72653-2910 | 2006-04-24 |
| 1295790780 | Gary Edward Bush | Internal Medicine | Va Medical Center, Mountain Home, Sidney and Lamont St, Mountain Home, TN 37684 | 2006-04-19 |
| Find all providers in MOUNTAIN HOME | ||||
| City | MOUNTAIN HOME |
| Zip Code | 37684 |
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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.