MICHAEL L BACON (NPI# 1780628891) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780628891 |
| Entity Type | Individual |
| Full Name | MICHAEL L BACON |
| Credential | MD |
| Practice Address |
130 West Ravine Road Kingsport TN 37662 |
| Mailing Address |
Po Box 11724 Knoxville TN 37939-1724 |
| Practice Telephone | 4232244000 |
| Practice Fax Number | 4232245120 |
| Mailing Telephone | 8657668800 |
| Mailing Fax Number | 8657668874 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2011-09-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 23688 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3072071 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184165425 | Michael Bacon | Family Medicine | 1514 Jefferson Hwy, New Orleans, LA 70121-2429 | 2017-03-20 |
| 1851832885 | Michael Bacon | Physical Therapist | 520 Rose Ln, Wickenburg, AZ 85390-1447 | 2017-03-09 |
| 1154795789 | Michael Bacon | Counselor | 11 Robinson St, Pottstown, PA 19464-6421 | 2015-11-19 |
| 1285794917 | Michael Bacon | Dentist | 8933 Market Pl, Ste. A, Everett, WA 98205-4909 | 2006-12-11 |
| 1912965799 | Michael J. Bacon | Family Medicine | 1937 M 119, Petoskey, MI 49770-8913 | 2006-05-02 |
| Street Address |
130 WEST RAVINE ROAD |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37662 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407982440 | Betty H Welch | Physical Therapist | 130 West Ravine Road, Kingsport, TN 37662 | 2007-02-26 |
| 1740372002 | Radiation Oncology Associates of N.e. Tn | Radiology | 130 West Ravine Road, Radiation Oncology Dept, Kingsport, TN 37660 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114178423 | Emma Jane Orr | Pharmacist | 135 West Ravine Road, Wellmont Holston Valley Medical Center Inpatient Pharm., Kingsport, TN 37662 | 2008-10-06 |
| 1356520845 | Ibrahim Heiba | Preventive Medicine | 200 S Wilcox Dr, Bldg 215, Kingsport, TN 37662 | 2007-10-31 |
| 1487771143 | Alicia Michelle Greer | Physical Therapy Assistant | 130 Ravine Rd, Kingsport, TN 37662 | 2007-03-26 |
| 1982634440 | Wellmont Health System, Inc | Emergency Medicine | 130 W Ravine Rd, Kingsport, TN 37662 | 2006-07-03 |
| 1245274430 | William E Devens Jr. | Emergency Medicine | 130 W Ravine Rd, Kingsport, TN 37662 | 2006-06-16 |
| 1063456291 | William D Hudson | Emergency Medicine | 130 W Ravine Rd, Kingsport, TN 37662 | 2006-06-16 |
| 1063630978 | Bruce James Poitrast | Preventive Medicine | 200 S. Wilcox Dr., B-215, Kingsport, TN 37662-5431 | 2007-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659972966 | Rebecca Singleton | Nurse Practitioner | 2601 N John B Dennis Hwy Apt 2318, Kingsport, TN 37660-0835 | 2020-11-03 |
| 1134727043 | Matthew Bronson King | Occupational Therapy Assistant | 1315 Riverbend Dr Apt 109, Kingsport, TN 37664-6004 | 2020-10-13 |
| 1386241800 | Melinda Ruth Hite | In Home Supportive Care | 2006 E Center St, Kingsport, TN 37664-2615 | 2020-10-07 |
| 1104433630 | Appalachian Pediatric Therapy, LLC | Behavioral Analyst | 5400 Fort Henry Dr Ste 12, Kingsport, TN 37663-5304 | 2020-09-29 |
| 1124634126 | Michael Haun | Chiropractor | 2105 E Center St Ste C, Kingsport, TN 37664-2664 | 2020-09-16 |
| 1033723499 | Courtney Lahatte Blankenship | Dentist | 116 Jack White Dr Ste 12, Kingsport, TN 37664-2379 | 2020-09-03 |
| 1932712528 | Shaylynn Hooper | Speech-Language Pathologist | 1076 Centerbrook Cir, Kingsport, TN 37663-2808 | 2020-08-25 |
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1316563455 | Kathleen Barksdale Beine | Family Medicine | 4515 Brookridge Dr, Kingsport, TN 37664-2105 | 2020-06-24 |
| 1467076158 | Jon Wirshels | Registered Nurse | 608 Montezuma Rd, Kingsport, TN 37664-4247 | 2020-05-29 |
| Find all providers in KINGSPORT | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285155531 | Terry Curtis Fultz | Emergency Medicine | 2807 Wallace Ct, Kingsport, TN 37664-5832 | 2017-06-27 |
| 1437347606 | Michael Mathson | Emergency Medicine | 130 W. Ravine Rd., Kingsport, TN 37660 | 2007-10-12 |
| 1275727281 | Ben John Kerny Jr. | Emergency Medicine | 278 Stone Edge Cir, Kingsport, TN 37660-3489 | 2007-09-03 |
| 1689795007 | Elaine Frazier | Emergency Medicine | 410 Golf Ridge Dr, Kingsport, TN 37664 | 2007-04-03 |
| 1700983376 | Sivasubramanian Krishnamoorthy | Emergency Medicine | 1901 Brookside Dr, Kingsport, TN 37660-4617 | 2006-09-17 |
| 1750498929 | Deborah E. Lecraw | Emergency Medicine | 105 W Stone Dr Ste 1f, Kingsport, TN 37660-3365 | 2006-08-24 |
| 1629012927 | Lesley Wilcoxson | Emergency Medicine | 1020 Stagshaw Ln, Kingsport, TN 37660-1077 | 2006-06-16 |
| 1598709727 | Vijay R Singh | Emergency Medicine | 1201 N Wilcox Dr, Suite B, Kingsport, TN 37660-4967 | 2006-06-16 |
| 1861470080 | Adil Kabir Warsy | Emergency Medicine | 2205 Pavilion Dr, Suite 201b, Kingsport, TN 37660-4641 | 2006-01-06 |
| 1477539542 | Michael P Kauzlarich | Emergency Medicine | 444 Clinchfield Street, Suite 201, Kingsport, TN 37660-3606 | 2005-12-20 |
| Find all providers in KINGSPORT | ||||
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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.