Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Larsen

Individual provider Family Medicine Physician · NPI 1972063444

Jack Larsen is a Family Practice in Johnson City, Tennessee. Qualified in 2019, 7 years ago. Practices with Medical Education Assistance Corporation, a 176-clinician group, works from 4 locations and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
7
Licensed in
TN
In the registry since
2019
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Practice location Address checks out

917 W Walnut St
Johnson City, TN 37604
Phone: (423) 439-6464
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 100 Newell Drive, Gainesville, FL 32610-3814 — (352) 265-4357
  • 208 Medical Park Blvd, Bristol, TN 37620 — (423) 989-4050
  • 102 E Ravine Rd, Kingsport, TN 37660-3814 — (423) 245-9600

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 63135 (TN)

Record details

NPI number1972063444
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 21, 2019
Last updated in NPPESJanuary 18, 2024
Certification dateJanuary 18, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Medical Education Assistance Corporation — 176 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Johnson City