1508803370 NPI number — FAMILY PRACTICE ASSOCIATES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508803370 NPI number — FAMILY PRACTICE ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PRACTICE ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508803370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 488
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37354-0488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-442-2622
Provider Business Mailing Address Fax Number:
423-442-5760

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4233 HIGHWAY 411
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37354-1571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-442-2622
Provider Business Practice Location Address Fax Number:
423-442-5760
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEVIN
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MD
Authorized Official Telephone Number:
423-442-2622

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3385847 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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