Individual ProviderMark BrummelFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address102 E Ravine Rd, Kingsport, TN 37660-3814(423) 245-9600(423) 433-6039PECOS EnrollmentBased on the most recent information from CMS, provider Mark Brummel is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1477619872Provider TypeIndividualFull NameBrummel, MarkTitleDr.CredentialD.O.GenderMaleSole ProprietorNoEnumeration Date12/29/2006Last Updated1/16/2024Contact InformationPractice LocationPractice Address102 E Ravine Rd, Kingsport, TN 37660-3814Phone(423) 245-9600Fax(423) 245-9634Mailing LocationMailing AddressPO Box 699, Mountain Home, TN 37684-0699Phone(423) 433-6039Fax(423) 433-6060Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseDO1970TennesseeProvider IdentifiersIDDescriptionIssuerID1507939DescriptionMedicaidIssuerUnlistedTennesseeID3714470DescriptionOtherIssuerGROUP MEDICARE PINTennessee