Organization
MCKENZIE MEDICAL CENTER
Active
Parent organization
MCKENZIE MEDICAL CENTER, PC
Other names
MMC URGENT CARE CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MCKENZIE MEDICAL CENTER, PC
Authorized official
LISA KAY PAGE (CREDENTIALING MANAGER)
(731) 352-7907
Entity
Organization
Contact information
Practice address
205 HOSPITAL DR, SUITE A, MC KENZIE, TN 38201-1649
(731) 352-7907
(731) 352-4459
Mailing address
205 HOSPITAL DR, SUITE A, MC KENZIE, TN 38201-1649
(731) 352-7907
(731) 352-4459
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD23833
TN
207R00000X
Internal Medicine Physician
MD15682
TN
208000000X
Pediatrics Physician
MD46412
TN
208600000X
Surgery Physician
MD45034
TN
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
PA1262
TN
363LF0000X
Family Nurse Practitioner
APN6244
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3380640
GROUP MEDICAID
TN
Enumeration date
11/14/2014
Last updated
10/24/2018
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