Provider Demographics
NPI:1164601399
Name:SHELBYVILLE CLINIC CORP
Entity Type:Organization
Organization Name:SHELBYVILLE CLINIC CORP
Other - Org Name:SHELBYVILLE ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:2839 HIGHWAY 231 NORTH
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-7448
Mailing Address - Country:US
Mailing Address - Phone:931-685-8770
Mailing Address - Fax:931-685-8771
Practice Address - Street 1:2839 HIGHWAY 231 NORTH
Practice Address - Street 2:SUITE 100
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7448
Practice Address - Country:US
Practice Address - Phone:931-685-8770
Practice Address - Fax:931-685-8771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBYVILLE CLINIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6007960003Medicare NSC