# BOLIVAR MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720297708
- **Authorized official:** DR. CHARLES L FROST M.D. (DOCTOR)
- **Authorized official phone:** (731) 658-7111

## Contact information

- **Practice address:** 610 NUCKOLLS RD, BOLIVAR, TN 38008-1532
- **Practice address phone:** (731) 658-7111
- **Practice address fax:** (731) 658-4328
- **Mailing address:** 610 NUCKOLLS RD, BOLIVAR, TN 38008-1532
- **Mailing address phone:** (731) 658-7111
- **Mailing address fax:** (731) 658-4328

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2007
- **Last updated:** 02/28/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2006653 | BLUECROSS BLUESHIELD | TN |
| 05 | — | 3720190 | — | TN |