Provider Demographics
NPI:1033536479
Name:LUNCEFORD FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:LUNCEFORD FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-384-9920
Mailing Address - Street 1:7865 EDUCATORS LN STE 300
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-8191
Mailing Address - Country:US
Mailing Address - Phone:901-384-9920
Mailing Address - Fax:901-937-7879
Practice Address - Street 1:7865 EDCATOR'S LN SUITE 300
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133
Practice Address - Country:US
Practice Address - Phone:901-384-9920
Practice Address - Fax:901-937-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000035471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3869544Medicare UPIN
TN103I119200Medicare UPIN