Organization
TRICITIES SKIN AND CANCER
Active
Organization
TRICITIES SKIN AND CANCER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDA SUE STUFFLESTREET (PRACTICE ADMINISTRATOR)
(423) 722-0565
Entity
Organization
Contact information
Practice address
1009 N STATE OF FRANKLIN ACCESS ROAD SUITE A, JOHNSON CITY, TN 37604
(423) 929-7546
(423) 929-7968
Mailing address
1009 N STATE OF FRANKLIN ACCESS ROAD, SUITE A, JOHNSON CITY, TN 37604-3693
(423) 929-7546
(423) 929-7968
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3150220
BLUECROSS/BLUESHIELD
TN
05
—
3720640
—
TN
01
—
CH2549
RR MEDICARE
TN
Enumeration date
10/12/2006
Last updated
03/17/2018
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up