NPIMap

Organization Active NPI

Brownsville Medical Clinic, P.a.

  • Family Medicine Physician
  • Brownsville, TN
National Provider Identifier
1659447696
Registry record updated Jul 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD8895 Issued in TN
Legal business name
BROWNSVILLE MEDICAL CLINIC, P.A.
Practice address
2565 N Washington Ave
Brownsville, TN 38012-1610
Phone
(731) 772-4199
Fax
(731) 772-7703
NPI assigned
Nov 28, 2006
Last updated
Jul 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2010

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

Authorized official

Name
Claudia White
Title
Administrator
Phone
(731) 772-4199

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Family Medicine Physician 207Q00000X MD8895 TN Primary

Addresses

Primary practice location

2565 N Washington Ave
Brownsville, TN 38012-1610

Mailing address

2565 N Washington Ave
Brownsville, TN 38012-1610
Phone (731) 772-4199

Other identifiers 4

IdentifierTypeStateIssuer
3156270MedicaidTN
3156277MedicaidTN
3386790MedicaidTN
3156276MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Locations

18 N Cavalier Dr
Alamo, TN 38001
Phone (731) 696-4500

2565 N Washington Ave
Brownsville, TN 38012
Phone (731) 772-4199

1864 Hwy 45 Byp
Jackson, TN 38305

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Aug 1, 2024 Change of OwnershipThis provider was the seller Brownsville Medical ClinicCCN 883810, TN, NPI 1386488922

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1659447696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2565 N WASHINGTON AVE",
            "city": "BROWNSVILLE",
            "state": "TN",
            "postal_code": "380121610",
            "telephone_number": "731-772-4199",
            "fax_number": "731-772-7703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2565 N WASHINGTON AVE",
            "city": "BROWNSVILLE",
            "state": "TN",
            "postal_code": "380121610",
            "telephone_number": "731-772-4199",
            "fax_number": "731-772-7703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROWNSVILLE MEDICAL CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "CLAUDIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "731-772-4199"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "MD8895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3156270",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3156277",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3386790",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3156276",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brownsville, TN

Sources for this page

Verify at the official NPI Registry.