Ten Broeck Tennessee Physicians Group Inc

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

TEN BROECK TENNESSEE PHYSICIANS GROUP INC

Doing business as

Memorial Senior Counseling Services

Practice address

45Oo Memorial Drive
Belleville, IL 62226-5399

Phone

(618) 257-5900

Fax

(618) 257-5463

NPI assigned

May 11, 2020

Last updated

May 11, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

TEN BROECK TENNESSEE PHYSICIANS GROUP INCAs reported in NPPES

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

Authorized official

Name

Glenda F Guy

Title

Director, Compliance

Phone

(931) 783-2511

Specialties & licenses 1

Addresses

Other names 1

• Memorial Senior Counseling Services Doing business as

Part of

Ten Broeck Tennessee Physicians

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589155200000",
    "number": "1275155418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385014294",
            "telephone_number": "931-783-2511",
            "fax_number": "931-783-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45OO MEMORIAL DRIVE",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265399",
            "telephone_number": "618-257-5900",
            "fax_number": "618-257-5463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "802 N 8th St",
            "address_purpose": "LOCATION",
            "city": "Vandalia",
            "state": "IL",
            "postal_code": "624711756",
            "country_code": "US",
            "telephone_number": "618-283-1731",
            "fax_number": "618-283-0590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TEN BROECK TENNESSEE PHYSICIANS GROUP INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TEN BROECK TENNESSEE PHYSICIANS GROUP INC",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-05-11",
        "certification_date": "2020-05-11",
        "status": "A",
        "authorized_official_last_name": "GUY",
        "authorized_official_first_name": "GLENDA",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "DIRECTOR, COMPLIANCE",
        "authorized_official_telephone_number": "931-783-2511"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Senior Counseling Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Mental Health Clinic/Center in Belleville, IL
• Providers in Belleville, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; 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.