Family Medical Clinic Of Trezevant | |
45 Hurt St Trezevant TN 38258-2505 | |
(731) 207-0323 | |
(731) 240-8065 |
Full Name | Family Medical Clinic Of Trezevant |
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Speciality | Clinic/Center |
Location | 45 Hurt St, Trezevant, Tennessee |
Authorized Official Name and Position | Deborah Kay Leggett (OWNER) |
Authorized Official Contact | 7312003001 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Family Medical Clinic Of Trezevant 45 Hurt St Trezevant TN 38258-2505 Ph: (731) 207-0323 | Family Medical Clinic Of Trezevant 45 Hurt St Trezevant TN 38258-2505 Ph: (731) 207-0323 |
NPI Number | 1538703897 |
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Provider Enumeration Date | 10/30/2019 |
Last Update Date | 03/31/2022 |
Medicare PECOS PAC ID | 2860828936 |
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Medicare Enrollment ID | O20200210000066 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538703897 | NPI | - | NPPES |
Q054230 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Tammy M Griffis |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1407251267 PECOS PAC ID: 8820310824 Enrollment ID: I20141202001405 |
Provider Name | Deborah Leggett |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528442688 PECOS PAC ID: 5496055600 Enrollment ID: I20151119001750 |
Provider Name | Cynthia Hinson Carroll |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1700367091 PECOS PAC ID: 9436588423 Enrollment ID: I20200325003866 |
Provider Name | Rhiannon Michelle Andresen |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1831750843 PECOS PAC ID: 0648699439 Enrollment ID: I20200928002684 |
Provider Name | Desiree Danielle Holland |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1811585920 PECOS PAC ID: 3274948443 Enrollment ID: I20210222000174 |