Bacon, Michael L

Bacon, Michael L is an individual health care provider with primary practice located at 130 West Ravine Road , Kingsport TN 37662. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Bacon, Michael L can be contacted via phone (423) 224-4000.

Contact Information

Primary practice address
130 West Ravine Road Kingsport TN 37662
Phone: (423) 224-4000
Fax: (423) 224-5120
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 23688 Tennessee

Profile Details

NPI number 1780628891
LBN Legal business name Bacon, Michael L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2006
Last updated Sep 26th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780628891 NPPES
Tennessee MEDICAID 3072071

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