Provider Demographics
NPI:1437297744
Name:BEMIS MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:BEMIS MEDICAL CLINIC, INC.
Other - Org Name:BEMIS MEDICAL CLINIC,INC II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND NURSE PRACTIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:731-422-6630
Mailing Address - Street 1:219 S MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-7464
Mailing Address - Country:US
Mailing Address - Phone:731-422-6630
Mailing Address - Fax:731-935-2866
Practice Address - Street 1:219 S MISSOURI ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-7464
Practice Address - Country:US
Practice Address - Phone:731-422-6630
Practice Address - Fax:731-935-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty