Organization
A PATTERN MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNEX LUBERISSE (DIRECTOR OF OPERATIONS)
(660) 229-0858
Entity
Organization
Contact information
Practice address
5545 LITTLE DEBBIE PKWY, OOLTEWAH, TN 37363-4357
(423) 455-2711
(423) 465-4589
Mailing address
5545 LITTLE DEBBIE PKWY, OOLTEWAH, TN 37363-4357
(660) 229-0858
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
AL
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q057324
—
TN
Enumeration date
08/03/2018
Last updated
09/06/2023
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