Organization
BOLIVAR MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES L FROST M.D. (DOCTOR)
(731) 658-7111
Entity
Organization
Contact information
Practice address
610 NUCKOLLS RD, BOLIVAR, TN 38008-1532
(731) 658-7111
(731) 658-4328
Mailing address
610 NUCKOLLS RD, BOLIVAR, TN 38008-1532
(731) 658-7111
(731) 658-4328
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2006653
BLUECROSS BLUESHIELD
TN
05
—
3720190
—
TN
Enumeration date
05/22/2007
Last updated
02/28/2011
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