Provider Demographics
NPI:1245414291
Name:CLARK & SANCHEZ HEALTH CENTER LLC
Entity Type:Organization
Organization Name:CLARK & SANCHEZ HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-661-0020
Mailing Address - Street 1:7101 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5236
Mailing Address - Country:US
Mailing Address - Phone:615-661-0020
Mailing Address - Fax:615-661-0030
Practice Address - Street 1:7101 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 175
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5236
Practice Address - Country:US
Practice Address - Phone:615-661-0020
Practice Address - Fax:615-661-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000000785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3303896Medicare PIN