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Wendy Tipton Oberdick

Family Medicine

Allopathic & Osteopathic Physicians

105 W Stone Dr, Ste 1f, Kingsport, TN 37660-3365

(423) 230-2420 (423) 857-2066

PECOS Enrollment

This provider is enrolled in PECOS as WENDY OBERDICK.

Based on the most recent information from CMS, provider Wendy Tipton Oberdick is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 4:18 PM.

Profile Details

Provider ID
1659374601
Provider Type
Individual
Full Name
Oberdick, Wendy Tipton
Credential
MD

Gender
Female
Sole Proprietor
Yes
Enumeration Date
5/23/2005
Last Updated
10/20/2011

Contact Information

Practice Location

105 W Stone Dr, Ste 1f, Kingsport, TN 37660-3365

(423) 230-2420

(423) 230-2422

Mailing Location

PO Box 9, Kingsport, TN 37662-0009

(423) 857-2066

(423) 857-2070

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License MD46567 Tennessee
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License 200133 Louisiana
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License MD200133 Louisiana

Provider Identifiers

ID	Description	Issuer
ID 1623512	Description Medicaid	Issuer Unlisted Louisiana
ID 1520114	Description Medicaid	Issuer Unlisted Tennessee

Wendy Tipton Oberdick

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

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Description

License

Code

Description

License

Code

Description

License

Code

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Provider Identifiers

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Description

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Description

Issuer

ID

Description

Issuer

Woodard, Jennifer Lynn

Stirman, Edward Monty

Winegar, Bruce C

Barakam, Neha

Kahle, Kelly

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Robbins, Sherry L

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Dr Susanne Toyne Md Pllc

Hubbs, Emily