NPIMap

Organization Active NPI

Family Medical Clinic of Trezevant

  • Primary Care Clinic/Center
  • Jackson, TN
National Provider Identifier
1215693171
Registry record updated Apr 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
FAMILY MEDICAL CLINIC OF TREZEVANT
Practice address
1022 Greystone SQ
Jackson, TN 38305-3580
Phone
(731) 300-2001
Fax
(731) 240-8095
NPI assigned
Nov 15, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2022

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

Authorized official

Name
Deborah Leggett, FNP-CNPI 1528442688
Title
Owner
Phone
(731) 300-2001

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

1022 Greystone SQ
Jackson, TN 38305-3580

Mailing address

1022 Greystone SQ
Jackson, TN 38305-3580
Phone (731) 300-2001

Other identifiers 1

IdentifierTypeStateIssuer
Q054230MedicaidTN

Other names 1

  • Family Medical Clinic of Jackson Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2185357Family Medical Clinic of Jackson1022 Greystone Square, Jackson, TN 38305Certificate of waiverJun 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Family Medical Clinic of Jackson2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1636934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1215693171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1022 GREYSTONE SQ",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053580",
            "telephone_number": "731-300-2001",
            "fax_number": "731-240-8095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1022 GREYSTONE SQ",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383053580",
            "telephone_number": "731-300-2001",
            "fax_number": "731-240-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CLINIC OF TREZEVANT",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-15",
        "last_updated": "2022-04-15",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "LEGGETT",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-300-2001",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q054230",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Clinic of Jackson",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.