Provider Demographics
NPI:1679741532
Name:HOLSTON REGIONAL COMPREHENSIVE MEDICINE
Entity type:Organization
Organization Name:HOLSTON REGIONAL COMPREHENSIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JPHN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TASKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-384-9266
Mailing Address - Street 1:1303 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2444
Mailing Address - Country:US
Mailing Address - Phone:423-384-2820
Mailing Address - Fax:423-239-9649
Practice Address - Street 1:1303 E CENTER ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2444
Practice Address - Country:US
Practice Address - Phone:423-384-9266
Practice Address - Fax:423-239-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6205721Medicaid
TNB58980Medicare UPIN
VA6205721Medicaid