The Kennedy Clinic Pllc | |
4957 Swinyar Dr Ste 109 Ooltewah TN 37363-2205 | |
(423) 396-9893 | |
(423) 396-9508 |
Full Name | The Kennedy Clinic Pllc |
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Speciality | Clinic/Center |
Location | 4957 Swinyar Dr Ste 109, Ooltewah, Tennessee |
Authorized Official Name and Position | Howard Michael Kennedy (MANAGING MEMBER) |
Authorized Official Contact | 4234323130 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
The Kennedy Clinic Pllc 4957 Swinyar Dr Suite 109 Ooltewah TN 37363 Ph: (423) 432-3130 | The Kennedy Clinic Pllc 4957 Swinyar Dr Ste 109 Ooltewah TN 37363-2205 Ph: (423) 396-9893 |
NPI Number | 1508078445 |
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Provider Enumeration Date | 05/04/2007 |
Last Update Date | 09/12/2024 |
Medicare PECOS PAC ID | 2769574219 |
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Medicare Enrollment ID | O20070828000948 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508078445 | NPI | - | NPPES |
1942280052 | Other | TN | KENNEDY NPI# |
413276426 | Other | TN | KENNEDY SS# |
4136940 | Other | TN | KENNEDY BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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