Organization
CORDOVA MEDICAL & COSMEDIC SOLUTIONS, PC
Active
Other names
Germantown Family Practice, PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARC J. CRUPIE M.D. (PRESIDENT)
(901) 507-4400
Entity
Organization
Contact information
Practice address
1025 CORDOVA STATION AVE, CORDOVA, TN 38018-6318
(901) 507-4400
(901) 756-5836
Mailing address
PO BOX 4438, CORDOVA, TN 38088-4438
(901) 507-4400
(901) 756-5836
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD15815
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3144579
BLUE CROSS BLUE SHIELD
TN
Enumeration date
03/06/2007
Last updated
01/15/2008
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