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130 N Main St Ridgely TN 38080-1317 | |
(731) 264-5518 | |
(731) 264-6859 |
Full Name | |
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Speciality | Clinic/Center |
Location | 130 N Main St, Ridgely, Tennessee |
Authorized Official Name and Position | Gayanne Cartwright Williams (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 7312536690 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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130 North Main Street Ridgely TN 38080-1317 Ph: (731) 264-5518 | 130 N Main St Ridgely TN 38080-1317 Ph: (731) 264-5518 |
NPI Number | 1851697817 |
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Provider Enumeration Date | 02/08/2011 |
Last Update Date | 02/08/2011 |
Medicare PECOS PAC ID | 6507052073 |
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Medicare Enrollment ID | O20101123000838 |
Identifier | Type | State | Issuer |
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1851697817 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6899 (Tennessee) | Primary |