Provider Demographics
NPI:1235515206
Name:PEDRO T. SALCEDO, M.D.,PLC
Entity Type:Organization
Organization Name:PEDRO T. SALCEDO, M.D.,PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:PULANCO
Authorized Official - Last Name:SALCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-906-8818
Mailing Address - Street 1:PO BOX 3749
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3749
Mailing Address - Country:US
Mailing Address - Phone:931-906-8818
Mailing Address - Fax:931-906-8898
Practice Address - Street 1:311 LANDRUM PL
Practice Address - Street 2:SUITE 200
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6319
Practice Address - Country:US
Practice Address - Phone:931-906-8818
Practice Address - Fax:931-906-8898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDRO T. SALCEDO,M.D.,PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28194305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3802904Medicaid
TN3802904Medicare PIN
TN3802904Medicaid