Provider Demographics
NPI:1255673380
Name:DOWNTOWN MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:DOWNTOWN MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-663-0951
Mailing Address - Street 1:113 HOPKINS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELLS
Mailing Address - State:TN
Mailing Address - Zip Code:38006
Mailing Address - Country:US
Mailing Address - Phone:731-663-0951
Mailing Address - Fax:731-663-0941
Practice Address - Street 1:113 HOPKINS AVENUE
Practice Address - Street 2:
Practice Address - City:BELLS
Practice Address - State:TN
Practice Address - Zip Code:38006
Practice Address - Country:US
Practice Address - Phone:731-663-0951
Practice Address - Fax:731-663-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAP0005413261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3347868Medicaid
TNS76345Medicare UPIN