| Pack Family Practice, Pllc | |
|
201 Signature Pl Ste 103 Lebanon TN 37087-3377 | |
| (615) 257-7778 | |
| (615) 235-3660 |
| Full Name | Pack Family Practice, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 201 Signature Pl Ste 103, Lebanon, Tennessee |
| Authorized Official Name and Position | Steven Henry Pack (PA) |
| Authorized Official Contact | 6152577778 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pack Family Practice, Pllc 201 Signature Pl Ste 103 Lebanon TN 37087-3377 Ph: (615) 257-7778 | Pack Family Practice, Pllc 201 Signature Pl Ste 103 Lebanon TN 37087-3377 Ph: (615) 257-7778 |
| NPI Number | 1649827197 |
|---|---|
| Provider Enumeration Date | 08/20/2019 |
| Last Update Date | 07/02/2024 |
| Medicare PECOS PAC ID | 6901210749 |
|---|---|
| Medicare Enrollment ID | O20210205001909 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649827197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Robert Joseph Jantz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396751749 PECOS PAC ID: 7911947130 Enrollment ID: I20110223000239 |
| Provider Name | Callie Tuggle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902295983 PECOS PAC ID: 8426378357 Enrollment ID: I20150518000677 |
| Provider Name | Leabeth M Pack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154747889 PECOS PAC ID: 9133425036 Enrollment ID: I20170323002372 |
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