Provider Demographics
NPI:1326114679
Name:CATRON SKIN CARE CENTER, PC
Entity Type:Organization
Organization Name:CATRON SKIN CARE CENTER, PC
Other - Org Name:CUMBERLAND SKIN & VEIN CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CATRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-456-5331
Mailing Address - Street 1:3496 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5424
Mailing Address - Country:US
Mailing Address - Phone:931-456-5331
Mailing Address - Fax:931-456-5332
Practice Address - Street 1:3496 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5424
Practice Address - Country:US
Practice Address - Phone:931-456-5331
Practice Address - Fax:931-456-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722868Medicaid
TN3722868Medicaid