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1501 12th Ave S Nashville TN 37203-4909 | |
| (615) 269-3461 | |
| (615) 383-1950 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1501 12th Ave S, Nashville, Tennessee |
| Authorized Official Name and Position | Mary A Bufwack (CEO) |
| Authorized Official Contact | 6152288902 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1501 12th Ave S Nashville TN 37203-4909 Ph: (615) 269-3461 | 1501 12th Ave S Nashville TN 37203-4909 Ph: (615) 269-3461 |
| NPI Number | 1033308960 |
|---|---|
| Provider Enumeration Date | 10/16/2007 |
| Last Update Date | 10/16/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033308960 | NPI | - | NPPES |
| 3661057 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Tennessee) | Primary |
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