Providence Medical Clinic LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PROVIDENCE MEDICAL CLINIC LLC

Practice address

2354 Highway 41 S
Greenbrier, TN 37073-5510

Phone

(615) 483-6675

NPI assigned

Oct 1, 2007

Last updated

Apr 29, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Randy E Florendo, M.D.NPI 1235124207

Title

Owner / Provider

Phone

(615) 483-6675

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16210/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randy Estacion Florendo, MD

  • Emergency Medicine Physician
  • Springfield, TN
  • NPI 1235124207
  Authorized official Same address or phone

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1124215405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 FOXRUN",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371727334",
            "telephone_number": "615-483-6675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2354 HIGHWAY 41 S",
            "city": "GREENBRIER",
            "state": "TN",
            "postal_code": "370735510",
            "telephone_number": "615-483-6675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-01",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "FLORENDO",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER / PROVIDER",
        "authorized_official_telephone_number": "615-483-6675",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "4159035",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jo Susan Offutt-Blackaby, MSN, PMHNP
• Cinthya C Ortiz Morales, FNP-C
• Lauren Pannell, DPT
• Patricia M Powers, FNP
• Kristina Opal Protzman, P.T.A
• RHC Group PLLC
• Lori Suggs, AMFT
• Makenzy Mary Margaret Thomas, RBT
• Amy Walter, RN, FNP-C
• Jennifer Washburn, LMSW

• Specialist in Greenbrier, TN
• Providers in Greenbrier, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; 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.