Organization
MCKENZIE MEDICAL CENTER PC
Active
Other names
Hometown Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY ETHERIDGE (CHIEF OPERATING OFFICER)
(731) 352-7907
Entity
Organization
Contact information
Practice address
30810 BROAD ST, BRUCETON, TN 38317-2028
(731) 586-4800
(833) 690-3848
Mailing address
205A HOSPITAL DR, MC KENZIE, TN 38201-1649
(731) 352-7907
(833) 690-3848
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ODT1599
TN
207Q00000X
Family Medicine Physician
MD23833
TN
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3380640
MEDICARE GROUP
TN
Enumeration date
03/18/2008
Last updated
05/06/2024
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