Provider Demographics
NPI:1457302598
Name:FAMILY CARE WALK IN CLINIC, INC.
Entity Type:Organization
Organization Name:FAMILY CARE WALK IN CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BEUERLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-660-6915
Mailing Address - Street 1:176 W UNIVERSITY PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1618
Mailing Address - Country:US
Mailing Address - Phone:731-660-6915
Mailing Address - Fax:731-668-4557
Practice Address - Street 1:176 W UNIVERSITY PKWY STE C
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1618
Practice Address - Country:US
Practice Address - Phone:731-660-6915
Practice Address - Fax:731-668-4557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2023-06-23
Deactivation Date:2023-05-17
Deactivation Code:
Reactivation Date:2023-06-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3378522Medicaid
TN3378522Medicaid