Provider Demographics
NPI:1033271812
Name:ALAMO FAMILY MEDICINE
Entity Type:Organization
Organization Name:ALAMO FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-696-5551
Mailing Address - Street 1:157 NORTH BELLS STREET
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001
Mailing Address - Country:US
Mailing Address - Phone:731-696-5551
Mailing Address - Fax:731-696-2802
Practice Address - Street 1:157 N BELLS ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-1767
Practice Address - Country:US
Practice Address - Phone:731-696-5551
Practice Address - Fax:731-696-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4576973261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728156Medicaid
TN3728156Medicaid