NPIMap

Organization Active NPI

North Willow Family Medicine LLC

  • Primary Care Clinic/Center
  • Cookeville, TN
National Provider Identifier
1124111356
Registry record updated May 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
NORTH WILLOW FAMILY MEDICINE LLC
Doing business as
North Willow Family Medicine LLC
Practice address
428 N Willow Ave
Cookeville, TN 38501-2339
Phone
(931) 372-7788
Fax
(031) 372-7799
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2012

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

Authorized official

Name
Dr. Eric Gregory Fox, M.D.NPI 1174565147
Title
Medical Director
Phone
(931) 372-7788

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

428 N Willow Ave
Cookeville, TN 38501-2339

Mailing address

428 N Willow Ave
Cookeville, TN 38501-2339
Phone (931) 372-7788

Other identifiers 2

IdentifierTypeStateIssuer
3883239MedicaidTN
4071388OtherTNBCBS

Other names 1

  • North Willow Family Medicine LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335916800000",
    "number": "1124111356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012339",
            "telephone_number": "931-372-7788",
            "fax_number": "031-372-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 N WILLOW AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012339",
            "telephone_number": "931-372-7788",
            "fax_number": "031-372-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH WILLOW FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2012-05-02",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "GREGORY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "931-372-7788",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3883239",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4071388",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Willow Family Medicine LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cookeville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; 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.