| Eastside Family Medical Clinic | |
|
104 Ivy Ln Pulaski TN 38478-4550 | |
| (931) 424-1330 | |
| (931) 424-0019 |
| Full Name | Eastside Family Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 104 Ivy Ln, Pulaski, Tennessee |
| Authorized Official Name and Position | Lisa Ann Weaver (OWNER) |
| Authorized Official Contact | 9314241330 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Family Medical Clinic 104 Ivy Ln Pulaski TN 38478-4550 Ph: (931) 424-1330 | Eastside Family Medical Clinic 104 Ivy Ln Pulaski TN 38478-4550 Ph: (931) 424-1330 |
| NPI Number | 1659447654 |
|---|---|
| Provider Enumeration Date | 11/28/2006 |
| Last Update Date | 02/02/2015 |
| Medicare PECOS PAC ID | 7214995703 |
|---|---|
| Medicare Enrollment ID | O20041230000228 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659447654 | NPI | - | NPPES |
| 3710887 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lisa Ann Weaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134124902 PECOS PAC ID: 0749248235 Enrollment ID: I20060130000340 |
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