Provider Demographics
NPI:1407042377
Name:FAMILY HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYE-ANNE
Authorized Official - Middle Name:B
Authorized Official - Last Name:AYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:8652-675-4342
Mailing Address - Street 1:11217 W POINT DR
Mailing Address - Street 2:STE 2
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2873
Mailing Address - Country:US
Mailing Address - Phone:865-675-4342
Mailing Address - Fax:865-675-4343
Practice Address - Street 1:11217 W POINT DR
Practice Address - Street 2:STE 2
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2873
Practice Address - Country:US
Practice Address - Phone:865-675-4342
Practice Address - Fax:865-675-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370183Medicaid
TN3370183Medicaid