| 493 Internal Medicine Pllc | |
|
493 Lantana Rd Crossville TN 38555-4946 | |
| (931) 335-9919 | |
| (931) 335-9954 |
| Full Name | 493 Internal Medicine Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 493 Lantana Rd, Crossville, Tennessee |
| Authorized Official Name and Position | Stephen D Clark (OWNER) |
| Authorized Official Contact | 9313359919 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 493 Internal Medicine Pllc 493 Lantana Rd Crossville TN 38555-4946 Ph: () - | 493 Internal Medicine Pllc 493 Lantana Rd Crossville TN 38555-4946 Ph: (931) 335-9919 |
| NPI Number | 1356994461 |
|---|---|
| Provider Enumeration Date | 07/17/2019 |
| Last Update Date | 08/05/2019 |
| Medicare PECOS PAC ID | 7719218775 |
|---|---|
| Medicare Enrollment ID | O20191007001792 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356994461 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Stephen Dennis Clark |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275727927 PECOS PAC ID: 5294823613 Enrollment ID: I20071119000659 |
| Provider Name | April L Thornton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952744740 PECOS PAC ID: 0042457715 Enrollment ID: I20130516000595 |
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