Provider Demographics
NPI:1316185937
Name:KABIR CLINIC LLC
Entity Type:Organization
Organization Name:KABIR CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:423-784-1197
Mailing Address - Street 1:488 S FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2382
Mailing Address - Country:US
Mailing Address - Phone:423-784-1197
Mailing Address - Fax:423-784-4647
Practice Address - Street 1:488 S FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2382
Practice Address - Country:US
Practice Address - Phone:423-784-1197
Practice Address - Fax:423-784-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26093207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty