Ten Broeck Tennessee Physicians Group Inc

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

TEN BROECK TENNESSEE PHYSICIANS GROUP INC

Practice address

802 N 8TH St
Vandalia, IL 62471-1756

Phone

(618) 283-1731

Fax

(618) 283-0590

NPI assigned

May 13, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Glenda F Guy

Title

Director, Compliance

Phone

(931) 783-2511

Specialties & licenses 1

Addresses

Other names 1

• Center for Senior Renewal Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589328000000",
    "number": "1083236012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014294",
            "telephone_number": "931-783-2511",
            "fax_number": "931-783-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 N 8TH ST",
            "city": "VANDALIA",
            "state": "IL",
            "postal_code": "624711756",
            "telephone_number": "618-283-1731",
            "fax_number": "618-283-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEN BROECK TENNESSEE PHYSICIANS GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-13",
        "last_updated": "2020-05-13",
        "certification_date": "2020-05-13",
        "status": "A",
        "authorized_official_last_name": "GUY",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR, COMPLIANCE",
        "authorized_official_telephone_number": "931-783-2511"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Senior Renewal",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lucinda M Spencer, APRN, FNP-C
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• Jessica Dawn Torbeck

• Adult Mental Health Clinic/Center in Vandalia, IL
• Providers in Vandalia, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.