| Pediatric Associates Of West Tennessee Pllc | |
|
1501 Brayton Ave Dyersburg TN 38024-3158 | |
| (731) 285-4111 | |
| Not Available |
| Full Name | Pediatric Associates Of West Tennessee Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1501 Brayton Ave, Dyersburg, Tennessee |
| Authorized Official Name and Position | Jamie L Ellerbrook (OWNER) |
| Authorized Official Contact | 7312854111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Associates Of West Tennessee Pllc 1501 Brayton Ave Dyersburg TN 38024-3158 Ph: (731) 285-4111 | Pediatric Associates Of West Tennessee Pllc 1501 Brayton Ave Dyersburg TN 38024-3158 Ph: (731) 285-4111 |
| NPI Number | 1679929285 |
|---|---|
| Provider Enumeration Date | 05/12/2016 |
| Last Update Date | 09/01/2016 |
| Medicare PECOS PAC ID | 2567740475 |
|---|---|
| Medicare Enrollment ID | O20161027002086 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679929285 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (Tennessee) | Primary |
| 363LP0200X | Nurse Practitioner - Pediatrics | 0000014756 (Tennessee) | Secondary |
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