Basic Information
| Provider Information | |||||||||
| NPI: | 1316016660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENGLEWOOD MEDICAL CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 321 W ATHENS ST | ||||||||
| Address2: | PO BOX 232 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373293269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232633779 | ||||||||
| FaxNumber: | 4232633607 | ||||||||
| Practice Location | |||||||||
| Address1: | 321 W ATHENS ST | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373293269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232633779 | ||||||||
| FaxNumber: | 4232633607 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | DOWNEY | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4232633600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WOODS MEMORIAL HOSPITAL DISTRICT | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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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 |
No ID Information.