Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 17 1st St E, Stanton, Tennessee |
Authorized Official Name and Position | Linda Lovelace (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 7316593125 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 720 Bolivar TN 38008-0720 Ph: () - | 17 1st St E Stanton TN 38069-4426 Ph: (731) 548-2232 |
NPI Number | 1356531610 |
---|---|
Provider Enumeration Date | 08/01/2007 |
Last Update Date | 06/27/2008 |
Medicare PECOS PAC ID | 5799694147 |
---|---|
Medicare Enrollment ID | O20030307000000 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356531610 | NPI | - | NPPES |
3340343 | Medicaid | TN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |