Provider Demographics
NPI:1164759601
Name:XAI FAMILY MEDICAL CLINIC
Entity Type:Organization
Organization Name:XAI FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:XAIYAVONG
Authorized Official - Middle Name:
Authorized Official - Last Name:SAENPHANSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:APN, FNP
Authorized Official - Phone:615-849-4081
Mailing Address - Street 1:315 ROBERT ROSE DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-6360
Mailing Address - Country:US
Mailing Address - Phone:615-849-4081
Mailing Address - Fax:615-895-0856
Practice Address - Street 1:315 ROBERT ROSE DR
Practice Address - Street 2:SUITE F
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-6360
Practice Address - Country:US
Practice Address - Phone:615-849-4081
Practice Address - Fax:615-895-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty