| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 176 Cude Ln, Madison, Tennessee |
| Authorized Official Name and Position | Jay Higham (CEO) |
| Authorized Official Contact | 2143656112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5001 Spring Valley Road Suite 600 East Dallas TX 75244 Ph: (214) 365-6100 | 176 Cude Ln Madison TN 37115-2202 Ph: (615) 281-6757 |
| NPI Number | 1306514583 |
|---|---|
| Provider Enumeration Date | 09/01/2021 |
| Last Update Date | 12/26/2024 |
| Certification Date | 12/26/2024 |
| Medicare PECOS PAC ID | 0042607186 |
|---|---|
| Medicare Enrollment ID | O20220420001133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306514583 | NPI | - | NPPES |
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