Organization
PREFERRED FAMILY MEDICAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH L KIDD FNP-BC (CEO)
(423) 665-3666
Entity
Organization
Contact information
Practice address
9026 HIWASSEE ST NE, CHARLESTON, TN 37310-5305
(423) 665-3666
(423) 584-6747
Mailing address
9026 HIWASSEE STREET NE, PO BOX 15, CHARLESTON, TN 37310
(423) 665-3666
(423) 584-6747
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
TN
261QS1200X
Sleep Disorder Diagnostic Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q007277
—
TN
Enumeration date
06/03/2014
Last updated
10/11/2021
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