Atoka Medical Clinic, Inc
Organization Active NPI Primary Care Clinic/Center · Atoka, TN
NPI 1104679299 · NPPES record last updated Jan 22, 2025
Key facts
- NPI
- 1104679299
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- ATOKA MEDICAL CLINIC, INC
- Practice address
- 60 Commercial Dr
Atoka, TN 38004-7042 - Phone
- (901) 296-1156
- Fax
- (901) 296-0430
- NPI assigned
- Apr 8, 2024
- Organization subpart
- No
Authorized official
- Name
- Mrs. Katrina Jo Korszoloski, FNP-C
- Title
- Family Nurse Practitioner, Owner
- Phone
- (901) 296-1156
Practitioners 3
-
Katrina Jo Korszoloski, FNP-C
-
Dana Poisal, DC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2307574 | Atoka Medical Clinic, Inc | Certificate of waiver | Jul 10, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240820002638 | TN | Part B Supplier - Clinic/Group Practice | 7911445069 |
Receives reassigned benefits from 1 practitioner Practice locations: Atoka, TN |
National Provider Directory
Locations
60 Commercial Dr
Atoka, TN 38004
Phone (901) 296-1156
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JEFEDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes | ||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
60 Commercial Dr
Atoka, TN 38004-7042
Mailing address
60 Commercial Dr
Atoka, TN 38004-7042
Phone (901) 296-1156
Other providers in Atoka, TN
- Shameela N Ahmed
- All in a Daze Transitions LLC
- Philip Gordon Andre
- Ashley Nicole Armstrong
- Kelli Askam
- Michael Bailey
- Kristen Marie Baskin
- Bell Internal Medicine PC
- Darl Vilbro Bell
- Oluwatosin Ayodeji Bewaji
All providers in Atoka, TN · Primary Care Clinic/Center in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.