Provider Demographics
NPI:1316016660
Name:ENGLEWOOD MEDICAL CLINIC
Entity Type:Organization
Organization Name:ENGLEWOOD MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-263-3600
Mailing Address - Street 1:321 W ATHENS ST
Mailing Address - Street 2:PO BOX 232
Mailing Address - City:ENGLEWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37329-3269
Mailing Address - Country:US
Mailing Address - Phone:423-263-3779
Mailing Address - Fax:423-263-3607
Practice Address - Street 1:321 W ATHENS ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:TN
Practice Address - Zip Code:37329-3269
Practice Address - Country:US
Practice Address - Phone:423-263-3779
Practice Address - Fax:423-263-3607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODS MEMORIAL HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370221Medicare Oscar/Certification