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4261 Big Creek Rd Hartford TN 37753-2220 | |
(423) 487-2249 | |
(423) 487-3707 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4261 Big Creek Rd, Hartford, Tennessee |
Authorized Official Name and Position | Larry A Stanifer (CEO) |
Authorized Official Contact | 8655090055 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4261 Big Creek Rd Hartford TN 37753-2220 Ph: (423) 487-2249 | 4261 Big Creek Rd Hartford TN 37753-2220 Ph: (423) 487-2249 |
NPI Number | 1871537639 |
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Provider Enumeration Date | 06/15/2006 |
Last Update Date | 01/28/2008 |
Medicare PECOS PAC ID | 1456384080 |
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Medicare Enrollment ID | O20071226000159 |
Identifier | Type | State | Issuer |
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1871537639 | NPI | - | NPPES |
0441858 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |