# MCKENZIE MEDICAL CENTER PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hometown Health Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245401231
- **Authorized official:** TAMMY ETHERIDGE (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (731) 352-7907

## Contact information

- **Practice address:** 30810 BROAD ST, BRUCETON, TN 38317-2028
- **Practice address phone:** (731) 586-4800
- **Practice address fax:** (833) 690-3848
- **Mailing address:** 205A HOSPITAL DR, MC KENZIE, TN 38201-1649
- **Mailing address phone:** (731) 352-7907
- **Mailing address fax:** (833) 690-3848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | ODT1599 | TN | — |
| 207Q00000X | Family Medicine Physician | MD23833 | TN | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/18/2008
- **Last updated:** 05/06/2024