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
205A HOSPITAL DR, MC KENZIE, TN 38201-1649
(731) 352-7907
(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
1041C0700X
Clinical Social Worker
LSW5620
TN
106H00000X
Marriage & Family Therapist
LMFT917
TN
152W00000X
Optometrist
ODT441
TN
207R00000X
Internal Medicine Physician
MD15682
TN
208000000X
Pediatrics Physician
MD46412
TN
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
PA1503
TN
363LF0000X
Family Nurse Practitioner
APN6244
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3380640
GROUP MEDICARE
TN
Enumeration date
04/07/2006
Last updated
12/03/2024
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