Basic Information
| Provider Information | |||||||||
| NPI: | 1255406450 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRADSHAW MEDICAL CLINIC, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1409 W. BADDOUR PKWY | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370872599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154444126 | ||||||||
| FaxNumber: | 6155471825 | ||||||||
| Practice Location | |||||||||
| Address1: | 1409 W. BADDOUR PKWY | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370872599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154444126 | ||||||||
| FaxNumber: | 6155471825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | MCFARLIN | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER/VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6154444126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | NP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | TN4167 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.