Basic Information
| Provider Information | |||||||||
| NPI: | 1174749469 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRIX-JENNINGS CLINIC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383402231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7319890001 | ||||||||
| FaxNumber: | 7319895151 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383402231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7319890001 | ||||||||
| FaxNumber: | 7319895151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | FRIX | ||||||||
| AuthorizedOfficialFirstName: | CAREY | ||||||||
| AuthorizedOfficialMiddleName: | WALLACE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7319890001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34823 | TN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | 34836 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | DA6267 | 01 | TN | RAILROAD MEDICARE | OTHER | 3372940 | 05 | TN | MEDICAID |