Provider Demographics
NPI:1508803370
Name:FAMILY PRACTICE ASSOCIATES, PC
Entity Type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-442-2622
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-0488
Mailing Address - Country:US
Mailing Address - Phone:423-442-2622
Mailing Address - Fax:423-442-5760
Practice Address - Street 1:4233 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-1571
Practice Address - Country:US
Practice Address - Phone:423-442-2622
Practice Address - Fax:423-442-5760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3385847Medicaid
TN443897Medicare Oscar/Certification
TN3385847Medicare PIN