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902 Highway 13 S Collinwood TN 38450-4614 | |
(931) 724-9135 | |
(931) 724-4572 |
Full Name | |
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Speciality | Clinic/Center |
Location | 902 Highway 13 S, Collinwood, Tennessee |
Authorized Official Name and Position | Charles J Brinkley (CFO) |
Authorized Official Contact | 9315404212 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 100054 Atlanta GA 30348-0054 Ph: (931) 796-4901 | 902 Highway 13 S Collinwood TN 38450-4614 Ph: (931) 724-9135 |
NPI Number | 1962117713 |
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Provider Enumeration Date | 01/17/2023 |
Last Update Date | 08/27/2024 |
Medicare PECOS PAC ID | 4688569718 |
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Medicare Enrollment ID | O20230131000700 |
Identifier | Type | State | Issuer |
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1962117713 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |