Provider Demographics
NPI:1164008553
Name:TEN BROECK TENNESSEE PHYSICIANS GROUP INC
Entity Type:Organization
Organization Name:TEN BROECK TENNESSEE PHYSICIANS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:KARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-319-4231
Mailing Address - Street 1:911 N SHELBY ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-2304
Mailing Address - Country:US
Mailing Address - Phone:812-883-8583
Mailing Address - Fax:812-883-8595
Practice Address - Street 1:911 N SHELBY ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-2304
Practice Address - Country:US
Practice Address - Phone:812-883-8583
Practice Address - Fax:812-883-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health