Organization
MCKENZIE MEDICAL CENTER LAB
Active
Other names
MCKENZIE MEDICAL CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA K PAGE (CREDENTIALING MANAGER)
(731) 352-7907
Entity
Organization
Contact information
Practice address
205 HOSPITAL DR, SUITE A, MC KENZIE, TN 38201-1649
(731) 352-7907
(731) 352-4459
Mailing address
205 HOSPITAL DR, SUITE A, MC KENZIE, TN 38201-1649
(731) 352-7907
(731) 352-4459
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD23833
TN
261QR1300X
Rural Health Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
MD23833
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3380640
—
TN
01
—
44D0315280
CLIA
—
Enumeration date
09/05/2007
Last updated
08/27/2019
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