| Tlc Family Care Pc | |
|
705 Howell St Sparta TN 38583-1008 | |
| (931) 739-0048 | |
| (931) 739-0047 |
| Full Name | Tlc Family Care Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 705 Howell St, Sparta, Tennessee |
| Authorized Official Name and Position | Doug Dodson (OFFICE MANAGER) |
| Authorized Official Contact | 9317390048 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tlc Family Care Pc 705 Howell St Sparta TN 38583-1008 Ph: (931) 739-0048 | Tlc Family Care Pc 705 Howell St Sparta TN 38583-1008 Ph: (931) 739-0048 |
| NPI Number | 1164649356 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 06/14/2010 |
| Medicare PECOS PAC ID | 8022022995 |
|---|---|
| Medicare Enrollment ID | O20060131000009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164649356 | NPI | - | NPPES |
| 3732621 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Mollie J Dodson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760486112 PECOS PAC ID: 6507845740 Enrollment ID: I20040720000422 |
| Provider Name | Jeanne Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154832459 PECOS PAC ID: 6305105099 Enrollment ID: I20180126000834 |
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