Provider Demographics
NPI:1033105051
Name:THE PEDIATRIC CENTER OF TULLAHOMA, PC
Entity Type:Organization
Organization Name:THE PEDIATRIC CENTER OF TULLAHOMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-455-7044
Mailing Address - Street 1:710 KINGS LN
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-5395
Mailing Address - Country:US
Mailing Address - Phone:931-455-7044
Mailing Address - Fax:931-455-7043
Practice Address - Street 1:710 KINGS LN
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-5395
Practice Address - Country:US
Practice Address - Phone:931-455-7044
Practice Address - Fax:931-455-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID