Organization
MERCY CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REXFORD YAO AGBENOHEVI MD (PRESIDENT AND CEO)
(931) 372-8668
Entity
Organization
Contact information
Practice address
315 N WASHINGTON AVE, SUITE 109, COOKEVILLE, TN 38501-2603
(931) 372-8668
Mailing address
315 N WASHINGTON AVE, SUITE 109, COOKEVILLE, TN 38501-2603
(931) 372-8668
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34431
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3855768
—
TN
01
—
4114708
BLUE CROSS BLUE SHIELD
TN
Enumeration date
05/03/2007
Last updated
08/22/2020
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