EASTLAKE PRIMARY CARE LLC (NPI# 1972043214) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972043214 |
| Entity Type | Organization |
| Organization Name | EASTLAKE PRIMARY CARE LLC |
| Other Organization Name | EASTLAKE PRIMARY CARE |
| Practice Address |
2500 Jacksboro Pike Ste 6 Jacksboro TN 37757-2818 |
| Mailing Address |
2500 Jacksboro Pike Suite 6 Jacksboro TN 37757 |
| Practice Telephone | (423) 352-6500 |
| Practice Fax Number | 4233526501 |
| Mailing Telephone | 4233526500 |
| Mailing Fax Number | 4233526501 |
| Enumeration Date | 2017-03-06 |
| 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 | 261QP2300X |
Clinic/Center Specialization: Primary Care |
TN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | Q027747 | 05 |
| Other Name | Type Code |
|---|---|
| Eastlake Primary 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 |
| 1467992446 | Eastlake Medical, LLC | Clinic/Center | 2500 Jacksboro Pike Ste 6, Jacksboro, TN 37757-2818 | 2017-02-24 |
| 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 | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780008656 | Neighborhood Medical LLC | Clinic/Center | 2702 Jacksboro Pike, Suite B, Jacksboro, TN 37757-4850 | 2014-02-12 |
| 1578939542 | Appa LLC | Clinic/Center | 3170 Appalachian Hwy, Jacksboro, TN 37757-5500 | 2015-08-13 |
| 1770750945 | Sushil B. Chokshi, M.d., P.a. | Clinic/Center | 217 W Belknap St, Jacksboro, TX 76458-2307 | 2008-05-15 |
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|---|---|---|---|---|
| 1780281527 | Braxton Medical Clinic, LLC | Clinic/Center | 1410 Kensington Square Ct Ste 103, Murfreesboro, TN 37130-6902 | 2020-10-05 |
| 1629689674 | Saint Thomas Medical Partners | Clinic/Center | 220 West Jefferson Pike, Murfreesboro, TN 37129 | 2020-08-13 |
| 1700411592 | Fentress Family Care LLC | Clinic/Center | 1010 Old Highway 127 S, Jamestown, TN 38556-5648 | 2020-03-11 |
| 1831724822 | Guiding Star Memphis | Clinic/Center | 2980 Poplar Ave Ste 101, Memphis, TN 38111-3527 | 2020-03-10 |
| 1407486764 | Elijahs Dream Compassionate Care | Clinic/Center | 134 Creekside Dr Ste 1, Ocoee, TN 37361-3653 | 2020-01-24 |
| 1518506542 | Faith Medical Group, Pllc | Clinic/Center | 500 Mcfarland St Ste E, Morristown, TN 37814-3992 | 2019-12-20 |
| 1366080582 | Matthew E. Schantz, M.d. | Clinic/Center | 206 S Military St Ste 1, Loretto, TN 38469-2101 | 2019-12-18 |
| 1114563749 | Step One Medical Associates PC | Clinic/Center | 4502 Bristol Hwy, Johnson City, TN 37601-2936 | 2019-11-19 |
| 1023665403 | Elite Healthcare, LLC | Clinic/Center | 117 N 3rd St, Kingston, TN 37763-2842 | 2019-08-21 |
| 1083266381 | Get Into Shape Md | Clinic/Center | 5803 Lee Hwy Ste 101, Chattanooga, TN 37421-3547 | 2019-07-16 |
| 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.