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Organization

TIDWELL FAMILY VENTURES LLC

Active
Other names
Portland Family Care and Walk-In Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
EMILY TIDWELL NP (MEMBER)
(615) 323-1020
Entity
Organization

Contact information

Practice address
505 S BROADWAY, PORTLAND, TN 37148-1438
(615) 323-1020
(615) 323-1021
Mailing address
505 S BROADWAY, PORTLAND, TN 37148-1438
(615) 323-1020
(615) 323-1021

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
1755
TN
363LA2100X
Acute Care Nurse Practitioner
Primary
10971
TN
363LF0000X
Family Nurse Practitioner
13982
TN

Other

Enumeration date
02/08/2009
Last updated
08/05/2009
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