| A Pattern Medical Clinic | |
|
5545 Little Debbie Pkwy Ooltewah TN 37363-4357 | |
| (423) 455-2711 | |
| (423) 465-4589 |
| Full Name | A Pattern Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 5545 Little Debbie Pkwy, Ooltewah, Tennessee |
| Authorized Official Name and Position | Annex Luberisse (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 6602290858 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Pattern Medical Clinic 5545 Little Debbie Pkwy Ooltewah TN 37363-4357 Ph: (660) 229-0858 | A Pattern Medical Clinic 5545 Little Debbie Pkwy Ooltewah TN 37363-4357 Ph: (423) 455-2711 |
| NPI Number | 1184102881 |
|---|---|
| Provider Enumeration Date | 08/03/2018 |
| Last Update Date | 09/06/2023 |
| Medicare PECOS PAC ID | 9436495595 |
|---|---|
| Medicare Enrollment ID | O20190109003536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184102881 | NPI | - | NPPES |
| Q057324 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Alabama) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Karen S Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1740384817 PECOS PAC ID: 9133112170 Enrollment ID: I20040406000875 |
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