Provider Demographics
NPI:1053610717
Name:MOUNTAIN MEDICAL SERVICES PLLC
Entity type:Organization
Organization Name:MOUNTAIN MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP DNP
Authorized Official - Phone:865-933-9950
Mailing Address - Street 1:2946 WINFIELD DUNN PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-4306
Mailing Address - Country:US
Mailing Address - Phone:865-933-9950
Mailing Address - Fax:
Practice Address - Street 1:2946 WINFIELD DUNN PKWY STE 107
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-4306
Practice Address - Country:US
Practice Address - Phone:865-933-9950
Practice Address - Fax:865-465-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 13355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty