1215322425 NPI number — BARTON FAMILY HEALTH CLINIC, LLC

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 1215322425 NPI number — BARTON FAMILY HEALTH CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARTON FAMILY HEALTH CLINIC, LLC
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:
1215322425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2835 E WOOD ST
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38242-5948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-407-9300
Provider Business Mailing Address Fax Number:
731-407-9301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2835 E WOOD ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38242-5948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-407-9300
Provider Business Practice Location Address Fax Number:
731-407-9301
Provider Enumeration Date:
04/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BARTON
Authorized Official First Name:
YVETTE
Authorized Official Middle Name:
COOPER
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
731-407-9300

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  15828 , 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: 03230949 . This is a "AMERIGROUP PROVIDER #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: INDIVIDUAL # Q006027 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6042199 . This is a "BCBS PROVIDER #" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1194018622 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1215322425 . This is a "GROUP NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: GROUP # Q013971 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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