Provider Demographics
NPI:1346381878
Name:DOCTORS' CLINIC OF UNION CITY, P.C.
Entity Type:Organization
Organization Name:DOCTORS' CLINIC OF UNION CITY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRADBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-885-5131
Mailing Address - Street 1:1020 REELFOOT AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5801
Mailing Address - Country:US
Mailing Address - Phone:731-885-5131
Mailing Address - Fax:731-885-5335
Practice Address - Street 1:1020 REELFOOT AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5801
Practice Address - Country:US
Practice Address - Phone:731-885-5131
Practice Address - Fax:731-885-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3375259Medicaid
TN3375259Medicaid