Basic Information
| Provider Information | |||||||||
| NPI: | 1952561979 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WARTRACE FAMILY PRACTICE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1612 N MAIN ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SHELBYVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371602391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316852022 | ||||||||
| FaxNumber: | 9316854158 | ||||||||
| Practice Location | |||||||||
| Address1: | 507 BLACKMAN BLVD W | ||||||||
| Address2: | |||||||||
| City: | WARTRACE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371832210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313890600 | ||||||||
| FaxNumber: | 9313896781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2008 | ||||||||
| LastUpdateDate: | 04/21/2009 | ||||||||
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| AuthorizedOfficialLastName: | PARSONS | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9316852022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD0000029483 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.