| Mercy Clinic, Inc | |
|
315 N Washington Ave Suite 109 Cookeville TN 38501-2603 | |
| (931) 372-8668 | |
| Not Available |
| Full Name | Mercy Clinic, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 315 N Washington Ave, Cookeville, Tennessee |
| Authorized Official Name and Position | Rexford Yao Agbenohevi (PRESIDENT AND CEO) |
| Authorized Official Contact | 9313728668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mercy Clinic, Inc 315 N Washington Ave Suite 109 Cookeville TN 38501-2603 Ph: (931) 372-8668 | Mercy Clinic, Inc 315 N Washington Ave Suite 109 Cookeville TN 38501-2603 Ph: (931) 372-8668 |
| NPI Number | 1710109962 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8123034410 |
|---|---|
| Medicare Enrollment ID | O20060223000407 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710109962 | NPI | - | NPPES |
| 4114708 | Other | TN | BLUE CROSS BLUE SHIELD |
| 3855768 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 34431 (Tennessee) | Primary |
| Provider Name | Rexford Y Agbenohevi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1679592869 PECOS PAC ID: 3476501602 Enrollment ID: I20050105000035 |
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