# BOULEVARD EAST FAMILY AND OCCUPATIONAL MEDICINE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Moses Benavides MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609948009
- **Authorized official:** MR. MOSES BENAIAH BENAVIDES MD (CEO)
- **Authorized official phone:** (423) 318-1185

## Contact information

- **Practice address:** 222 BOWMAN ST, SUITE 3, MORRISTOWN, TN 37813-3856
- **Practice address phone:** (423) 318-1185
- **Practice address fax:** (423) 318-1015
- **Mailing address:** 1443 W MORRIS BLVD, SUITE B, MORRISTOWN, TN 37813
- **Mailing address phone:** (423) 318-1185
- **Mailing address fax:** (423) 318-1015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QC1500X | Community Health Clinic/Center | MD0000040290 | TN | — |
| 261QC1800X | Corporate Health Clinic/Center | MD0000040290 | TN | — |
| 261QD0000X | Dental Clinic/Center | DS0000007577 | TN | — |
| 261QM1103X | Military Ambulatory Procedure Visits Operational (Transportable) Clinic/Center | MD0000040290 | TN | — |
| 261QM1300X | Multi-Specialty Clinic/Center | MD 0000040290 | TN | — |
| 261QP2300X | Primary Care Clinic/Center | MD0000040290 | TN | — |
| 261QU0200X | Urgent Care Clinic/Center | MD0000040290 | TN | — |
| 261QX0100X | Occupational Medicine Clinic/Center | MD0000040290 | TN | — |

## Other

- **Enumeration date:** 11/14/2006
- **Last updated:** 03/07/2023