Basic Information
| Provider Information | |||||||||
| NPI: | 1629136379 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEDFORD FAMILY PRACTICE URGENT CARE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1612 NORTH MAIN STREET | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371602610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316852022 | ||||||||
| FaxNumber: | 9316854158 | ||||||||
| Practice Location | |||||||||
| Address1: | 1612 NORTH MAIN STREET | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371602610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316852022 | ||||||||
| FaxNumber: | 9316854158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 06/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | LYNETTE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9316808910 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 0443937 | 05 | TN | MEDICAID |