NPIMap

Organization Active NPI

Ten Broeck Tennessee Physicians Group Inc

Doing business as Senior Renewal Center: Jennings

  • Adult Mental Health Clinic/Center
  • North Vernon, IN
National Provider Identifier
1952988115
Registry record updated Mar 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
TEN BROECK TENNESSEE PHYSICIANS GROUP INC
Doing business as
Senior Renewal Center: Jennings
Practice address
301 Henry St BLDG C
North Vernon, IN 47265-1030
Phone
(812) 352-2430
Fax
(812) 382-2431
NPI assigned
Mar 25, 2021
Last updated
Mar 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2021

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

Authorized official

Name
Karissa Hutson
Title
Business Office
Phone
(931) 319-4231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

301 Henry St BLDG C
North Vernon, IN 47265-1030

Mailing address

301 Henry St BLDG C
North Vernon, IN 47265-1030
Phone (812) 352-2430

Other names 1

  • Senior Renewal Center: Jennings Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ten Broeck TN Physicians7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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": "1616630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616630400000",
    "number": "1952988115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 HENRY ST BLDG C",
            "city": "NORTH VERNON",
            "state": "IN",
            "postal_code": "472651030",
            "telephone_number": "812-352-2430",
            "fax_number": "812-382-2431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 HENRY ST BLDG C",
            "city": "NORTH VERNON",
            "state": "IN",
            "postal_code": "472651030",
            "telephone_number": "812-352-2430",
            "fax_number": "812-382-2431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEN BROECK TENNESSEE PHYSICIANS GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-25",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "HUTSON",
        "authorized_official_first_name": "KARISSA",
        "authorized_official_title_or_position": "BUSINESS OFFICE",
        "authorized_official_telephone_number": "931-319-4231"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Senior Renewal Center: Jennings",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Vernon, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; 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.