Organization
YOUTHCARE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS EDWARD MITORAJ MD (OWNER)
(423) 968-4007
Entity
Organization
Contact information
Practice address
212 MIDWAY MEDICAL PARK, BRISTOL, TN 37620-1664
(423) 968-4007
(423) 652-2590
Mailing address
212 MIDWAY MEDICAL PARK, BRISTOL, TN 37620-1664
(423) 968-4007
(423) 652-2590
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
021345
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006746080
—
VA
01
—
0123498
BLUE CROSS TN
TN
01
—
042029
ANTHEM
VA
05
—
3060577
—
TN
Enumeration date
09/22/2010
Last updated
09/22/2010
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