Provider Demographics
NPI:1326118837
Name:TANGLEWOOD MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:TANGLEWOOD MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:MARIE-THERESE
Authorized Official - Last Name:VANDEWIELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-735-3555
Mailing Address - Street 1:259 DIXON SPRINGS HWY
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-2161
Mailing Address - Country:US
Mailing Address - Phone:615-735-3555
Mailing Address - Fax:615-735-3588
Practice Address - Street 1:259 DIXON SPRINGS HWY
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-2161
Practice Address - Country:US
Practice Address - Phone:615-735-3555
Practice Address - Fax:615-735-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729742Medicare ID - Type UnspecifiedCLINIC'S MEDICARE NUMBER