ETLOG MANAGEMENT SERVICE (NPI# 1932750189) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932750189 |
| Entity Type | Organization |
| Organization Name | ETLOG MANAGEMENT SERVICE |
| Other Organization Name | HHOMECARE |
| Practice Address |
1005 Carrington Ct Kingsport TN 37660-5694 |
| Practice Telephone | 4236777040 |
| Mailing Telephone | 4236777040 |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2020-09-08 |
| Authorized Official Name | DR. YAW OTCHERE-BOATENG (CEO) |
| Authorized Official Telephone | 4236777040 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | ETLOG MANAGEMENT SERVICE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities | ||
| N | 261QV0200X |
Clinic/Center Specialization: VA |
Ambulatory Health Care Facilities | ||
| N | 291U00000X | Clinical Medical Laboratory | Laboratories | ||
| N | 251B00000X | Case Management | Agencies | ||
| N | 251J00000X | Nursing Care | Agencies | ||
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| N | 261QR0208X |
Clinic/Center Specialization: Radiology, Mobile |
Ambulatory Health Care Facilities | ||
| N | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities | ||
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities | ||
| N | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
Ambulatory Health Care Facilities | ||
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| ETLOGMS | Doing Business As Name - Organization |
| HHOMECare | Doing Business As Name - Organization |
| Street Address |
1005 CARRINGTON CT |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660-5694 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326665019 | Karolina Bocian | Nurse Practitioner | 1005 Carrington Ct, Kingsport, TN 37660-5694 | 2020-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
| 1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
| 1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
| 1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
| 1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
| 1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| Find all providers in zip 37660 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
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| 1457976714 | Blue Light Therapies LLC | Clinic/Center | 421 E Royal Ln Suite 100, Irving, TN 75039 | 2020-06-12 |
| 1174147870 | Freedom Medical Services Pllc | Clinic/Center | 1203 Laurel Springs Way, Signal Mountain, TN 37377-1445 | 2020-05-29 |
| 1023630019 | Daya Medicals, Inc. | Clinic/Center | 460 S Highland St, Memphis, TN 38111-4302 | 2020-05-12 |
| 1518421148 | Paramount Solutions Clinic & Laboratory Testing | Clinic/Center | 2010 Church St Ste 624, Nashville, TN 37203-2075 | 2019-01-28 |
| 1982180113 | Abundant Healthcare Clinic LLC | Clinic/Center | 130 Serral Dr, Greeneville, TN 37745-3074 | 2018-07-11 |
| 1649776691 | Serious Health Services | Clinic/Center | 715 Cherry St Ste 207, Chattanooga, TN 37402-1929 | 2018-03-30 |
| 1124523287 | Hands of Health and Rehab | Clinic/Center | 80 N. Tillman St. Ste. 104, Memphis, TN 38111 | 2018-03-29 |
| 1205377348 | Southeastern Swallowing Diagnostics | Clinic/Center | 8459 Lexie Ln, Ooltewah, TN 37363-5796 | 2017-03-08 |
| 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.