Provider Demographics
NPI:1316228075
Name:CLINCHFIELD FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:CLINCHFIELD FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:GRIGSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-378-1500
Mailing Address - Street 1:2204 PAVILION DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4657
Mailing Address - Country:US
Mailing Address - Phone:423-378-1500
Mailing Address - Fax:423-378-1520
Practice Address - Street 1:2204 PAVILION DR
Practice Address - Street 2:SUITE 110
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4657
Practice Address - Country:US
Practice Address - Phone:423-378-1500
Practice Address - Fax:423-378-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000042820261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527171Medicaid
VA1316228075Medicaid
TN103G701399Medicare PIN