| Life Source Of Centerville | |
|
132a N Central Ave Centerville TN 37033 | |
| (931) 729-4001 | |
| (931) 729-4081 |
| Full Name | Life Source Of Centerville |
|---|---|
| Speciality | Clinic/Center |
| Location | 132a N Central Ave, Centerville, Tennessee |
| Authorized Official Name and Position | Robert E Wilson (SOLE OWNER) |
| Authorized Official Contact | 9317294001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Source Of Centerville Po Box 99 Centerville TN 37033-0099 Ph: (931) 729-4001 | Life Source Of Centerville 132a N Central Ave Centerville TN 37033 Ph: (931) 729-4001 |
| NPI Number | 1366957656 |
|---|---|
| Provider Enumeration Date | 12/07/2017 |
| Last Update Date | 06/11/2018 |
| Medicare PECOS PAC ID | 2961767637 |
|---|---|
| Medicare Enrollment ID | O20180530000738 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366957656 | NPI | - | NPPES |
| 6128617 | Other | BLUE CROSS BLUE SHIED OF TENNESSEE | |
| 1144589458 | Other | NPPES - INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Robert Wilson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1144589458 PECOS PAC ID: 1759514979 Enrollment ID: I20140423002134 |
Dermal Solutions Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 107 S Central Ave, Centerville, TN 37033 Phone: 931-729-0012 Fax: 931-729-0012 | |
Saint Thomas Hickman Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1518 Highway 100, Centerville, TN 37033 Phone: 931-729-3091 | |
Ascension Saint Thomas Hickman Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 150 E Swan Street, Centerville, TN 37033 Phone: 931-729-3091 Fax: 931-729-0809 |