Provider Demographics
NPI:1124218631
Name:FAMILY MEDICAL CENTER OF DECHERD INC.
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER OF DECHERD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:931-962-4082
Mailing Address - Street 1:3651 TULLAHOMA HWY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-4940
Mailing Address - Country:US
Mailing Address - Phone:931-962-4082
Mailing Address - Fax:931-962-4084
Practice Address - Street 1:3651 TULLAHOMA HWY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-4940
Practice Address - Country:US
Practice Address - Phone:931-962-4082
Practice Address - Fax:931-962-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341708OtherMEDICARE PPN
TN3724619Medicaid
TN3724619OtherRAILROAD MEDICARE
TNS11830Medicare UPIN
TN3341708OtherMEDICARE PPN