Provance, Paul Thomas
Provance, Paul Thomas is an individual health care provider with primary practice located at James H Quillen Va Medical Center , Mountain Home TN 37684-4000. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Provance, Paul Thomas can be contacted via phone (423) 926-1171.Contact Information
Primary practice address
James H Quillen Va Medical Center
Mountain Home TN 37684-4000
Phone: (423) 926-1171
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 35.086268 | Ohio |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD41434 | Tennessee |
Profile Details
| NPI number | 1760429740 |
|---|---|
| LBN Legal business name | Provance, Paul Thomas |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 31st, 2006 |
| Last updated | Nov 8th, 2010 - about 16 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760429740 | NPPES |
| Tennessee | MEDICAID | 3825653 | |
| Tennessee | MEDICAID | 2571293 |
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