Organization
PROVIDENCE MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY E FLORENDO M.D. (OWNER / PROVIDER)
(615) 483-6675
Entity
Organization
Contact information
Practice address
2354 HIGHWAY 41 S, GREENBRIER, TN 37073-5510
(615) 483-6675
Mailing address
172 FOXRUN, SPRINGFIELD, TN 37172-7334
(615) 483-6675
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4159035
BLUE CROSS BLUE SHEILD
TN
Enumeration date
10/01/2007
Last updated
04/29/2008
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