Basic Information
| Provider Information | |||||||||
| NPI: | 1538805023 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTTS HILL MEDICAL CLINIC, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 187 | ||||||||
| Address2: | |||||||||
| City: | SCOTTS HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383740187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315491000 | ||||||||
| FaxNumber: | 7315491011 | ||||||||
| Practice Location | |||||||||
| Address1: | 644 HIGHWAY 114 S | ||||||||
| Address2: | |||||||||
| City: | SCOTTS HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383745023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315491000 | ||||||||
| FaxNumber: | 7315491011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2022 | ||||||||
| LastUpdateDate: | 05/09/2022 | ||||||||
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| AuthorizedOfficialLastName: | DELANEY | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7315491000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
| NPICertificationDate: | 05/09/2022 | ||||||||
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 | 1154308849 | 01 | TN | FNP | OTHER | 1275168080 | 01 | TN | FNP | OTHER | 1871577684 | 01 | TN | FNP | OTHER |