Organization
MARTIN HEALTH
Active
Other names
West Tennessee Medical Group Primary Care Martin
Organization subpart
No
Provider details
NPI number
Authorized official
BARTLEY TEAGUE (EXECUTIVE DIRECTOR)
(731) 512-1277
Entity
Organization
Contact information
Practice address
143 KENNEDY DRIVE, MARTIN, TN 38237-3309
(731) 587-5321
(731) 588-3229
Mailing address
143 KENNEDY DRIVE, MARTIN, TN 38237-3309
(731) 587-5321
(731) 588-3229
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
0000000126
TN
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044-3452
—
TN
01
—
0757
MEDICARE PART B PTAN
—
Enumeration date
03/15/2017
Last updated
10/03/2022
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