McMinnville Medical Associates PLLC
Organization Active NPI Internal Medicine Physician · MC Minnville, TN
NPI 1104937267 · NPPES record last updated Nov 10, 2020
Key facts
- NPI
- 1104937267
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- MCMINNVILLE MEDICAL ASSOCIATES PLLC
- Practice address
- 1514 Sparta St
MC Minnville, TN 37110-1317 - Phone
- (931) 473-8400
- Fax
- (931) 473-0620
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Harry E Burck Jr., M.D.
- Title
- Gen PTR
- Phone
- (931) 473-8400
Practitioners 5
-
Lacey L Jones, FNP
-
Shauna Samuel, MSN, APRN, FNP-C
-
Philip Stewart, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D0967308 | McMinnville Medical Associates, PLLC | Certificate of waiver | Apr 30, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060419000335 | TN | Part B Supplier - Clinic/Group Practice | 0446269484 |
Receives reassigned benefits from 5 practitioners Practice locations: McMinnville, TN |
National Provider Directory
Locations
1514 Sparta St
McMinnville, TN 37110
Phone (931) 473-8400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
1514 Sparta St
MC Minnville, TN 37110-1317
Mailing address
1514 Sparta St
MC Minnville, TN 37110-1317
Phone (931) 473-8400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3719411 | Medicaid | TN |
Other providers in MC Minnville, TN
- Charles Wallace Marsh III
- Murphy Colson Martin
- Stanley R Martin
- Mary Jane Jamieson
- McMinnville Emergency Services LLC
- McMinnville Medical Care Center LLC
- McMinnville Residential, LLC
- McMinnville Warren County Senior Center, Inc.
- Mid-South Respicare,Inc.
- Middle Tennessee Surgical Care
All providers in MC Minnville, TN · Internal Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 10, 2020. 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.