OrganizationMountain Region Family Medicine, PcFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address444 Clinchfield Street, Ste 201, Kingsport, TN 37660-3683(423) 230-2100PECOS EnrollmentBased on the most recent information from CMS, provider Mountain Region Family Medicine, Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 4:18 PM.Profile DetailsProvider ID1831467067Provider TypeOrganizationFull NameMountain Region Family Medicine, PcSubpartNoEnumeration Date12/2/2011Last Updated3/10/2017Contact InformationPractice LocationPractice Address444 Clinchfield Street, Ste 201, Kingsport, TN 37660-3683Phone(423) 230-2100Fax(423) 230-2112Mailing LocationMailing Address444 Clinchfield Street, Ste 201, Kingsport, TN 37660-3683Phone(423) 230-2100Fax(423) 230-2112Authorized OfficialNameTrent, Wanda Y (Corporate Secretary)Phone(423) 230-2109Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerTennesseeProvider IdentifiersIDDescriptionIssuerID1003827205DescriptionOtherIssuerNPIID1538110309DescriptionOtherIssuerNPIID1154354900DescriptionOtherIssuerNPIID1164582862DescriptionOtherIssuerNPIID1528079910DescriptionOtherIssuerNPIID1548252638DescriptionOtherIssuerNPIID1861732968DescriptionOtherIssuerNPITennesseeID1881854594DescriptionOtherIssuerNPITennesseeID1356391098DescriptionOtherIssuerNPIID1477539542DescriptionOtherIssuerNPIID1526748DescriptionMedicaidIssuerUnlistedTennesseeID1629089784DescriptionOtherIssuerNPIID1770534539DescriptionOtherIssuerNPIID1306897202DescriptionOtherIssuerNPIID1588676456DescriptionOtherIssuerNPIID3386406DescriptionOtherIssuerMEDICARE PTAN (S. STEFFEY)ID4312365DescriptionOtherIssuerBLUE CROSS BLUE SHIELD GROUPTennessee