Organization
GTW, LLC
Active
Organization
GTW, LLC
Active
Other names
TRISTAR FAMILY CARE
Organization subpart
No
Provider details
NPI number
Authorized official
LISA KAY PAGE (CREDENTIALING MANAGER)
(731) 693-3465
Entity
Organization
Contact information
Practice address
126 W PARIS ST, HUNTINGDON, TN 38344-3608
(731) 535-3600
(731) 535-3603
Mailing address
PO BOX 506, HUNTINGDON, TN 38344-0506
(731) 431-2579
(731) 499-8175
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q071950
—
TN
Enumeration date
02/15/2022
Last updated
04/14/2022
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