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
811 MORROW ST STE 207, DRESDEN, TN 38225-1847
(731) 364-4900
(833) 690-3848
Mailing address
205A HOSPITAL DR, MC KENZIE, TN 38201-1649
(731) 352-7907
(731) 352-4459
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
ODT1599
TN
207Q00000X
Family Medicine Physician
MD23833
TN
261Q00000X
Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
PA1262
TN
363LF0000X
Family Nurse Practitioner
APN14751
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3380640
GROUP MEDICARE NUMBER
TN
05
—
Q018764
—
TN
Enumeration date
10/09/2009
Last updated
05/06/2024
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