Organization
BISHOFBERGER MEDICAL ASSOCIATES OF EAST TENNESSEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS E BISHOFBERGER MD (OWNER)
(423) 784-1300
Entity
Organization
Contact information
Practice address
188 HOSPITAL LN, JELLICO, TN 37762-4400
(423) 784-1300
(423) 784-1420
Mailing address
1381 RELIABLE PKWY, CHICAGO, IL 60686-0013
(317) 216-2528
(317) 216-2894
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
41757
TN
261QM2500X
Medical Specialty Clinic/Center
Primary
41757
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174681639
MEDICARE RAILROAD CARRIER -GROUP MEMBER NPI
—
01
—
1649442237
MEDICARE RAILROAD CARRIER -GROUP NPI
—
01
—
41757
TN LICENSURE
TN
01
—
4177360
BLUECROSS BLUESHIELD OF TENN
TN
01
—
DQ1434
MEDICARE RAILROAD CARRIER -GROUP PTAN
—
01
—
P00817876
MEDICARE RAILROAD CARRIER -GROUP MEMBER PTAN
—
Enumeration date
03/24/2008
Last updated
12/01/2011
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