| Jack Pettigrew Pllc | |
|
514 W College St Brownsville TN 38012-3711 | |
| (731) 432-9461 | |
| Not Available |
| Full Name | Jack Pettigrew Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 514 W College St, Brownsville, Tennessee |
| Authorized Official Name and Position | Jack Pettigrew (OWNER) |
| Authorized Official Contact | 7314329461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack Pettigrew Pllc Po Box 1452 Brownsville TN 38012-1452 Ph: (731) 432-9461 | Jack Pettigrew Pllc 514 W College St Brownsville TN 38012-3711 Ph: (731) 432-9461 |
| NPI Number | 1508369703 |
|---|---|
| Provider Enumeration Date | 03/14/2018 |
| Last Update Date | 03/14/2018 |
| Medicare PECOS PAC ID | 7517221757 |
|---|---|
| Medicare Enrollment ID | O20180516000215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508369703 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jack G Pettigrew |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780798058 PECOS PAC ID: 0547253924 Enrollment ID: I20111031000792 |
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