NPIMap

Organization Active NPI

McKenzie Medical Center Lab

Doing business as McKenzie Medical Center

  • Family Medicine Physician
  • McKenzie, TN
National Provider Identifier
1477747293
Registry record updated Aug 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD23833 Issued in TN
Legal business name
MCKENZIE MEDICAL CENTER LAB
Doing business as
McKenzie Medical Center
Practice address
205 Hospital Dr
Suite a
MC Kenzie, TN 38201-1649
Phone
(731) 352-7907
Fax
(731) 352-4459
NPI assigned
Sep 5, 2007
Last updated
Aug 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2019

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

Authorized official

Name
Mrs. Lisa K Page
Title
Credentialing Manager
Phone
(731) 352-7907

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Clinical Medical Laboratory 291U00000X MD23833 TN
Family Medicine Physician 207Q00000X MD23833 TN Primary

Addresses

Primary practice location

205 Hospital Dr
Suite a
MC Kenzie, TN 38201-1649

Mailing address

205 Hospital Dr
Suite a
MC Kenzie, TN 38201-1649
Phone (731) 352-7907

Other identifiers 2

IdentifierTypeStateIssuer
3380640MedicaidTN
44D0315280OtherCLIA

Other names 1

  • MCKENZIE MEDICAL CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
McKenzie Medical Center10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566864000000",
    "number": "1477747293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 HOSPITAL DR",
            "address_2": "SUITE A",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382011649",
            "telephone_number": "731-352-7907",
            "fax_number": "731-352-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 HOSPITAL DR",
            "address_2": "SUITE A",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382011649",
            "telephone_number": "731-352-7907",
            "fax_number": "731-352-4459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKENZIE MEDICAL CENTER LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2019-08-27",
        "status": "A",
        "authorized_official_last_name": "PAGE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "731-352-7907",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "TN",
            "license": "MD23833",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD23833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3380640",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "44D0315280",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCKENZIE MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MCKENZIE MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McKenzie, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2019; 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.