Provider Demographics
NPI:1508871302
Name:CARTHAGE FAMILY PRACTICE SPECIALISTS, PC
Entity Type:Organization
Organization Name:CARTHAGE FAMILY PRACTICE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-735-5401
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-0176
Mailing Address - Country:US
Mailing Address - Phone:615-735-0700
Mailing Address - Fax:615-735-5480
Practice Address - Street 1:133 HOSPITAL DR
Practice Address - Street 2:SUITE 500
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-4004
Practice Address - Country:US
Practice Address - Phone:615-735-0700
Practice Address - Fax:615-735-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3389733Medicaid
TN3389733Medicare PIN