Provider Demographics
NPI:1275796880
Name:FAMILY PRACTICE CENTER OF TULLAHOMA LLC
Entity Type:Organization
Organization Name:FAMILY PRACTICE CENTER OF TULLAHOMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATSIMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-454-0489
Mailing Address - Street 1:100 WILLIAM NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-4754
Mailing Address - Country:US
Mailing Address - Phone:931-454-0489
Mailing Address - Fax:931-454-1227
Practice Address - Street 1:100 WILLIAM NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-4754
Practice Address - Country:US
Practice Address - Phone:931-454-0489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4314517OtherBCBS
TN1527567Medicaid
TN4314517OtherBCBS