Organization
BROADWAY FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHANNON SHULTZ (OWNER)
(865) 993-1070
Entity
Organization
Contact information
Practice address
1179 HIGHWAY 11W, BEAN STATION, TN 37708
(865) 993-1070
(865) 993-1075
Mailing address
1179 HIGHWAY 11W, BEAN STATION, TN 37708-5809
(865) 993-1070
(865) 993-1075
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
06/08/2017
Last updated
07/21/2022
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