Provider Demographics
NPI:1164546057
Name:MCMINNVILLE MEDICAL CARE CENTER LLC
Entity Type:Organization
Organization Name:MCMINNVILLE MEDICAL CARE CENTER LLC
Other - Org Name:MCMINNVILLE MEDICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:KRIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:931-474-6622
Mailing Address - Street 1:PO BOX 7086
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37111-7086
Mailing Address - Country:US
Mailing Address - Phone:931-474-6622
Mailing Address - Fax:931-474-6625
Practice Address - Street 1:457 N CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2049
Practice Address - Country:US
Practice Address - Phone:931-474-6622
Practice Address - Fax:931-474-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty