Provider Demographics
NPI:1518192582
Name:WOBEGONE, INC.
Entity Type:Organization
Organization Name:WOBEGONE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-860-8822
Mailing Address - Street 1:P.O. BOX 2019
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37116-2019
Mailing Address - Country:US
Mailing Address - Phone:615-860-8822
Mailing Address - Fax:615-865-7598
Practice Address - Street 1:355 NEW SHACKLE ISLAND ROAD
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2300
Practice Address - Country:US
Practice Address - Phone:615-338-1258
Practice Address - Fax:615-338-1251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty