Provider Demographics
NPI:1104366988
Name:NEIGHBORHOOD CLINIC, PLLC
Entity Type:Organization
Organization Name:NEIGHBORHOOD CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-499-2319
Mailing Address - Street 1:1190 PETTIJOHN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HENRY
Mailing Address - State:TN
Mailing Address - Zip Code:38231-4123
Mailing Address - Country:US
Mailing Address - Phone:731-499-2319
Mailing Address - Fax:866-670-8568
Practice Address - Street 1:201 N BREWER ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4027
Practice Address - Country:US
Practice Address - Phone:731-415-3574
Practice Address - Fax:731-240-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026850Medicaid