Organization
LA MANAGEMENT COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY WEBB (PRESIDENT)
(931) 252-0541
Entity
Organization
Contact information
Practice address
1125 DEER CREEK DR, COOKEVILLE, TN 38501-6680
(931) 252-0541
(931) 432-4242
Mailing address
1125 DEER CREEK DR, COOKEVILLE, TN 38501-6680
(931) 252-0541
(931) 432-4242
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H445473
TENNCARE GROUP PROVIDER #
TN
Enumeration date
11/17/2010
Last updated
11/17/2010
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