Provider Demographics
NPI:1265822027
Name:CLINIC AT SELMER, PC
Entity Type:Organization
Organization Name:CLINIC AT SELMER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:SAID
Authorized Official - Last Name:BAKEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-645-7952
Mailing Address - Street 1:714 FEDERAL DR
Mailing Address - Street 2:
Mailing Address - City:SELMER
Mailing Address - State:TN
Mailing Address - Zip Code:38375-1876
Mailing Address - Country:US
Mailing Address - Phone:731-645-7952
Mailing Address - Fax:731-645-8898
Practice Address - Street 1:714 FEDERAL DR
Practice Address - Street 2:
Practice Address - City:SELMER
Practice Address - State:TN
Practice Address - Zip Code:38375-1876
Practice Address - Country:US
Practice Address - Phone:731-645-7952
Practice Address - Fax:731-645-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-02
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000015732174400000X
TNAPN0000019130363L00000X
TNAPN0000019129363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1780671255OtherNPI
TN3010022Medicaid
TN1780671255OtherNPI
TN3010022Medicare PIN