| Mednorth Group Pllc | |
|
3000 Greystone Sq Jackson TN 38305-3589 | |
| (731) 664-5150 | |
| (731) 664-5059 |
| Full Name | Mednorth Group Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3000 Greystone Sq, Jackson, Tennessee |
| Authorized Official Name and Position | Joseph David Blankenship (OWNER AND PRESIDENT) |
| Authorized Official Contact | 7316645150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mednorth Group Pllc 3000 Greystone Sq Jackson TN 38305-3589 Ph: (731) 664-5150 | Mednorth Group Pllc 3000 Greystone Sq Jackson TN 38305-3589 Ph: (731) 664-5150 |
| NPI Number | 1770549693 |
|---|---|
| Provider Enumeration Date | 04/21/2006 |
| Last Update Date | 02/23/2012 |
| Medicare PECOS PAC ID | 3577519719 |
|---|---|
| Medicare Enrollment ID | O20050330000715 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770549693 | NPI | - | NPPES |
| 1430 | Other | TN | TLC |
| 3729018 | Medicaid | TN | |
| 165539 | Other | TN | UNISON HEALTH PLAN |
| 4102813 | Other | TN | BCBST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Joe D Blankenship |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1437115763 PECOS PAC ID: 7315916467 Enrollment ID: I20050408000314 |
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