Provider Demographics
NPI:1194835645
Name:DEBORAH VERBEEK
Entity Type:Organization
Organization Name:DEBORAH VERBEEK
Other - Org Name:ARDMORE FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:VERBEEK
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:931-427-6969
Mailing Address - Street 1:25495 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:TN
Mailing Address - Zip Code:38449-3129
Mailing Address - Country:US
Mailing Address - Phone:931-427-6969
Mailing Address - Fax:931-427-6967
Practice Address - Street 1:25495 MAIN ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:TN
Practice Address - Zip Code:38449-3129
Practice Address - Country:US
Practice Address - Phone:931-427-6969
Practice Address - Fax:931-427-6967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529905610Medicaid
TN3712867Medicare PIN