Basic Information
| Provider Information | |||||||||
| NPI: | 1043252620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTIAN FAMILY MEDICINE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHRISTIAN FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 79 HIGHWAY 51 S | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380634580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316358189 | ||||||||
| FaxNumber: | 7316358121 | ||||||||
| Practice Location | |||||||||
| Address1: | 79 HIGHWAY 51 S | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380634580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316358189 | ||||||||
| FaxNumber: | 7316358121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 02/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | VIA | ||||||||
| AuthorizedOfficialFirstName: | RUSTE | ||||||||
| AuthorizedOfficialMiddleName: | SHELBY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7313432730 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3727405 | 05 | TN | MEDICAID |