| Cordova Medical & Cosmedic Solutions, Pc | |
|
1025 Cordova Station Ave Cordova TN 38018-6318 | |
| (901) 507-4400 | |
| (901) 756-5836 |
| Full Name | Cordova Medical & Cosmedic Solutions, Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1025 Cordova Station Ave, Cordova, Tennessee |
| Authorized Official Name and Position | Marc J. Crupie (PRESIDENT) |
| Authorized Official Contact | 9015074400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cordova Medical & Cosmedic Solutions, Pc Po Box 4438 Cordova TN 38088-4438 Ph: (901) 507-4400 | Cordova Medical & Cosmedic Solutions, Pc 1025 Cordova Station Ave Cordova TN 38018-6318 Ph: (901) 507-4400 |
| NPI Number | 1831229475 |
|---|---|
| Provider Enumeration Date | 03/06/2007 |
| Last Update Date | 01/15/2008 |
| Medicare PECOS PAC ID | 5890872352 |
|---|---|
| Medicare Enrollment ID | O20080408000382 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831229475 | NPI | - | NPPES |
| 3144579 | Other | TN | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MD15815 (Tennessee) | Primary |
| Provider Name | Marc J Crupie |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467543140 PECOS PAC ID: 5991882458 Enrollment ID: I20080408000376 |
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