Provider Demographics
NPI:1326187980
Name:CARMEL CLINIC CORPORATION
Entity Type:Organization
Organization Name:CARMEL CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MUHAMED
Authorized Official - Middle Name:SALAH
Authorized Official - Last Name:FAOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-680-1559
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37162
Mailing Address - Country:US
Mailing Address - Phone:931-680-1560
Mailing Address - Fax:931-680-1561
Practice Address - Street 1:2762 HWY 231 NORTH
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160
Practice Address - Country:US
Practice Address - Phone:931-680-1560
Practice Address - Fax:931-680-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37844207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4143375OtherBCBS
TN4143376OtherBCBS TN
TN3370128Medicaid
TN4143376OtherBCBS TN
TNH89958Medicare UPIN