Organization
MOUNTAIN REGION FAMILY MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WANDA Y TRENT (CORPORATE SECRETARY)
(423) 230-2109
Entity
Organization
Contact information
Practice address
444 CLINCHFIELD STREET, STE 201, KINGSPORT, TN 37660-3683
(423) 230-2100
(423) 230-2112
Mailing address
444 CLINCHFIELD STREET, STE 201, KINGSPORT, TN 37660-3683
(423) 230-2100
(423) 230-2112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003827205
NPI
—
01
—
1154354900
NPI
—
01
—
1164582862
NPI
—
01
—
1306897202
NPI
—
01
—
1356391098
NPI
—
01
—
1477539542
NPI
—
05
—
1526748
—
TN
01
—
1528079910
NPI
—
01
—
1538110309
NPI
—
01
—
1548252638
NPI
—
01
—
1588676456
NPI
—
01
—
1629089784
NPI
—
01
—
1770534539
NPI
—
01
—
1861732968
NPI
TN
01
—
1881854594
NPI
TN
01
—
3386406
MEDICARE PTAN (S. STEFFEY)
—
01
—
4312365
BLUE CROSS BLUE SHIELD GROUP
TN
Enumeration date
12/02/2011
Last updated
03/10/2017
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