| Imac | |
|
345 W Broad St Cookeville TN 38501-2331 | |
| (931) 528-2300 | |
| (931) 528-2305 |
| Full Name | Imac |
|---|---|
| Speciality | Internal Medicine |
| Location | 345 W Broad St, Cookeville, Tennessee |
| Authorized Official Name and Position | Audrey Karen Tolbert (OWNER) |
| Authorized Official Contact | 9315282300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imac 345 W Broad St Cookeville TN 38501-2331 Ph: (931) 528-2300 | Imac 345 W Broad St Cookeville TN 38501-2331 Ph: (931) 528-2300 |
| NPI Number | 1992824163 |
|---|---|
| Provider Enumeration Date | 03/28/2007 |
| Last Update Date | 11/06/2023 |
| Medicare PECOS PAC ID | 1456477926 |
|---|---|
| Medicare Enrollment ID | O20100922000657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992824163 | NPI | - | NPPES |
| 3715929 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Nikki L Adams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891778817 PECOS PAC ID: 1951406040 Enrollment ID: I20070418000418 |
| Provider Name | Audrey Karen Tolbert |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346240009 PECOS PAC ID: 5890810147 Enrollment ID: I20100910000335 |
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