Organization
TAZEWELL MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONDAL KEITH BROCK P.A.C. (PRESIDENT)
(423) 626-6145
Entity
Organization
Contact information
Practice address
1442 N BROAD ST, SUITE 7, TAZEWELL, TN 37879-4361
(423) 626-6145
(423) 526-2804
Mailing address
1442 N BROAD ST, SUITE 7, TAZEWELL, TN 37879-4361
(423) 626-6145
(423) 526-2804
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
PA476
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4043299
BCBS-T GROUP NUMBER
TN
Enumeration date
01/23/2007
Last updated
08/22/2020
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