Provider Demographics
NPI:1174294797
Name:TENN-TOM MED LLC
Entity Type:Organization
Organization Name:TENN-TOM MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:662-427-4040
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38833-0214
Mailing Address - Country:US
Mailing Address - Phone:662-427-4040
Mailing Address - Fax:662-427-4041
Practice Address - Street 1:369 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MS
Practice Address - Zip Code:38833-9320
Practice Address - Country:US
Practice Address - Phone:662-427-4040
Practice Address - Fax:662-427-4041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care