FOUNDATION MEDICAL, INC. (NPI# 1336636158) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336636158 |
| Entity Type | Organization |
| Organization Name | FOUNDATION MEDICAL, INC. |
| Practice Address |
1730 Old Gray Station Rd Johnson City TN 37615-3869 |
| Practice Telephone | 4232023008 |
| Practice Fax Number | 4232027835 |
| Mailing Telephone | 4232023008 |
| Mailing Fax Number | 4232027835 |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2019-07-24 |
| Authorized Official Name | JENNIFER TEAGUE GOOD (FACILITY DIRECTOR/OWNER) |
| Authorized Official Telephone | 4232023008 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
1000000022019 | TN | Allopathic & Osteopathic Physicians |
| Street Address |
1730 OLD GRAY STATION RD |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37615-3869 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568962983 | Clayton Kilgore | Pharmacist | 208 Suncrest St Unit 1, Gray, TN 37615 | 2018-02-13 |
| 1346648268 | Jesse Mullins | Pharmacist | 121 Boone Ridge Dr, Suite 1006, Johnson City, TN 37615 | 2014-12-09 |
| 1750650875 | Medical Education Assistance Corporation | Pediatrics | 252 Sam Jenkins Rd, Attn: Dr. H. Patrick Stern, Gray, TN 37615 | 2011-12-19 |
| 1700018603 | Anna Lynne Deal | Nurse Practitioner | 119 Boone Ridge Dr., Ste. 201, Johnson City, TN 37615 | 2009-08-11 |
| 1285876631 | Leigh A Furman | Occupational Therapist | 253 Wiltshire Dr., Gray, TN 37615 | 2009-04-01 |
| 1811098908 | Fay Lynn Bembry | Nurse Practitioner | 119 Boone Ridge Drive Ste. 201, Johnson City, TN 37615 | 2006-09-25 |
| 1871528976 | Boones Creek Medical Pllc | Family Medicine | 2685 Boones Creek Road, Suite 104, Johnson City, TN 37615 | 2006-07-11 |
| 1568402048 | Joseph Vincent Pinyard Jr. | Family Medicine | 880 Boones Station Rd, Johnson City, TN 37615 | 2006-06-07 |
| 1548223084 | Pitchar Theerathorn | Internal Medicine | 119 Boone Ridge Drive, Suite 201, Johnson City, TN 37615 | 2006-04-07 |
| 1194717157 | Susan Kay Pennypacker | Nurse Practitioner | 140 Old Gray Station Rd, Suite 200, Gray, TN 37615 | 2005-08-16 |
| Find all providers in zip 37615 | ||||
| Taxonomy Code | 207QA0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Addiction Medicine |
| A family medicine physician who specializes in the diagnosis and treatment of addictions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) was, but is no longer issued by the American Osteopathic Board of Family Physicians. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912418435 | Sunrise Medical Associates Inc. | Family Medicine | 9 Worth Cir Ste 100, Johnson City, TN 37601-4358 | 2017-10-24 |
| 1831640937 | Watauga Recovery Center Morristown P.C. | Family Medicine | 1369 W Andrew Johnson Hwy, Johnson City, TN 37604 | 2016-10-24 |
| 1336330596 | Matthew John Caffrey | Family Medicine | 102 N Broadway St, Johnson City, TN 37601-3525 | 2007-08-05 |
| 1568402048 | Joseph Vincent Pinyard Jr. | Family Medicine | 880 Boones Station Rd, Johnson City, TN 37615 | 2006-06-07 |
| 1336483262 | Watauga Recovery Center | Family Medicine | 3114 Browns Mill Rd, Johnson City, TN 37604 | 2012-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811508765 | Pw-hospital Bridge Services, LLC | Family Medicine | 801 Hill St Ste A, Springfield, TN 37172-2951 | 2020-08-13 |
| 1285268243 | Alpha Medical Center, LLC | Family Medicine | 1421 W Baddour Pkwy Ste A, Lebanon, TN 37087-2652 | 2020-02-28 |
| 1770133597 | Renewal Healthcare | Family Medicine | 7035 Middlebrook Pike, Knoxville, TN 37909 | 2019-09-13 |
| 1518425941 | Hamm, Blackstock & Stern, Pllc | Family Medicine | 2135 Dalkeith Dr, Germantown, TN 38139-3407 | 2019-03-05 |
| 1770080632 | East Tennessee Addiction Specialists | Family Medicine | 2022 Chilhowee Medical Park, Maryville, TN 37804-5285 | 2018-04-09 |
| 1851810774 | Physician Hope and Wellness Center | Family Medicine | 1915c Church St, Nashville, TN 37203-2203 | 2017-09-12 |
| 1619409489 | Watauga Recovery Center Greeneville | Family Medicine | 819 W Church Street, Greeneville, TN 37745 | 2017-03-31 |
| 1568913663 | Watauga Recovery Center Newport PC | Family Medicine | 330 Heritage Blvd, Newport, TN 37821-4257 | 2016-10-24 |
| 1861949547 | Roger P. Sherman, M.d., P.l.l.c. | Family Medicine | 211 Donelson Pike Ste 102, Nashville, TN 37214 | 2016-09-09 |
| 1740639962 | Jabbok Treatment Center, LLC. | Family Medicine | 40 Irwin St, Savannah, TN 38372-3084 | 2016-06-08 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37615 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.