Broadway Family Practice – Primary Care Clinic/Center

Key facts

NPI: 1578092938
Entity type: Organization (NPI type 2)
Primary specialty: Primary Care Clinic/Center 261QP2300X
Legal business name: BROADWAY FAMILY PRACTICE
Practice address: 1179 Highway 11W
Bean Station, TN 37708
Phone: (865) 993-1070
Fax: (865) 993-1075
NPI assigned: Jun 8, 2017
Organization subpart: No

Authorized official

Name: Mr. Shannon Shultz
Title: Owner
Phone: (865) 993-1070

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Primary Care Clinic/Center	261QP2300X			Yes

Addresses

Primary practice location

1179 Highway 11W
Bean Station, TN 37708

Mailing address

1179 Highway 11W
Bean Station, TN 37708-5809
Phone (865) 993-1070

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1578092938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 HIGHWAY 11W",
            "city": "BEAN STATION",
            "state": "TN",
            "postal_code": "377085809",
            "telephone_number": "865-993-1070",
            "fax_number": "865-993-1075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 HIGHWAY 11W",
            "city": "BEAN STATION",
            "state": "TN",
            "postal_code": "37708",
            "telephone_number": "865-993-1070",
            "fax_number": "865-993-1075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SHULTZ",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-993-1070",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bean Station, TN

All providers in Bean Station, TN · Primary Care Clinic/Center in Tennessee

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.