Provider Demographics
NPI:1295208874
Name:LWC SEVICE PROVIDERS LLP
Entity Type:Organization
Organization Name:LWC SEVICE PROVIDERS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-201-5926
Mailing Address - Street 1:111 ELLISON RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3025
Mailing Address - Country:US
Mailing Address - Phone:423-201-5926
Mailing Address - Fax:
Practice Address - Street 1:111 ELLISON RD STE 2
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3025
Practice Address - Country:US
Practice Address - Phone:423-201-5926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1538583158OtherNPI
TN1861892424OtherNPI
TN1922199330OtherNPI