| Notlob Enterprises | |
|
260 W 5th St Cookeville TN 38501-1754 | |
| (931) 432-5849 | |
| (931) 400-0489 |
| Full Name | Notlob Enterprises |
|---|---|
| Speciality | Clinic/Center |
| Location | 260 W 5th St, Cookeville, Tennessee |
| Authorized Official Name and Position | James Wade Bolton (PROVIDER) |
| Authorized Official Contact | 9314325849 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Notlob Enterprises 3624 Long Lane Rd Cookeville TN 38506-8012 Ph: (214) 876-1248 | Notlob Enterprises 260 W 5th St Cookeville TN 38501-1754 Ph: (931) 432-5849 |
| NPI Number | 1386123222 |
|---|---|
| Provider Enumeration Date | 08/11/2018 |
| Last Update Date | 03/20/2019 |
| Medicare PECOS PAC ID | 4587909007 |
|---|---|
| Medicare Enrollment ID | O20190102001802 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386123222 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Jennifer K Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992174528 PECOS PAC ID: 5092015206 Enrollment ID: I20151119001546 |
| Provider Name | James Wade Bolton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477559649 PECOS PAC ID: 4385743822 Enrollment ID: I20190102001919 |
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