McKenzie Medical Center PC
Organization Active NPI Clinic/Center · MC Kenzie, TN
NPI 1679195036 · NPPES record last updated Jun 17, 2024
Key facts
- NPI
- 1679195036
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- MCKENZIE MEDICAL CENTER PC
- Practice address
- 205C Hospital Dr
MC Kenzie, TN 38201-1649 - Phone
- (731) 352-7907
- Fax
- (833) 690-3848
- NPI assigned
- May 8, 2020
- Organization subpart
- No
Authorized official
- Name
- Tammy Etheridge
- Title
- Chief Operating Office
- Phone
- (731) 352-7907
Other NPIs on the same Medicare enrollment 7
Corporate family (same tax ID) 9
Practitioners 5
-
Hope Newell, PA
-
Matthew W Roberts, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040619000083 | TN | Part B Supplier - Clinic/Group Practice | 2365427853 |
Receives reassigned benefits from 34 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Trenton, TN; McKenzie, TN; MC Kenzie, TN; Huntingdon, TN; Gleason, TN; Dresden, TN; Camden, TN; Bruceton, TN… |
National Provider Directory
- Tax ID family
- McKenzie Medical Center Lab
Locations
205 Hospital Dr
Ste C
Mc Kenzie, TN 38201
Phone (731) 207-8560
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X |
Addresses
Primary practice location
205C Hospital Dr
MC Kenzie, TN 38201-1649
Mailing address
205A Hospital Dr
MC Kenzie, TN 38201-1649
Phone (731) 352-7907
Other names
- Hometown Health Clinic
Other providers in MC Kenzie, TN
- McKenzie Medical Center
- McKenzie Medical Center
- McKenzie Medical Center Lab
- McKenzie Medical Center PC
- McKenzie Medical Center PC
- McKenzie Medical Center PC
- McKenzie SNF Healthcare LLC
- McKenzie Tennessee Hospital Company LLC
- McKenzie Tennessee Hospital Company LLC
- McKenzie Tennessee Hospital Company LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.