Basic Information
| Provider Information | |||||||||
| NPI: | 1881939965 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY HEALTH CENTER OF ASHLAND CITY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 342 FREY ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370151734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157921199 | ||||||||
| FaxNumber: | 6157929331 | ||||||||
| Practice Location | |||||||||
| Address1: | 342 FREY ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370151734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157921199 | ||||||||
| FaxNumber: | 6157929331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2012 | ||||||||
| LastUpdateDate: | 11/30/2012 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | DUFF | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6157921199 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 0443930 | 05 | TN | MEDICAID |