Organization
STATE OF TENNESSEE
Active
Other names
Metro Moore Health Facility
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA J WHITWELL (OFFICE SUPERVISOR)
(931) 490-8334
Entity
Organization
Contact information
Practice address
251 MAJORS BLVD, LYNCHBURG, TN 37352-8352
(931) 759-4251
(931) 759-6380
Mailing address
251 MAJORS BLVD, LYNCHBURG, TN 37352-8352
(931) 759-4251
(931) 759-6380
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119549
BC/BS & TENNCARE SELECT
TN
01
—
3065987
TENNCARE SELECT PCP
TN
05
—
4448000
—
TN
Enumeration date
07/21/2006
Last updated
09/25/2012
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