Provider Demographics
NPI:1568798635
Name:FALL CREEK MEDICAL MANAGEMENT, P.C.
Entity Type:Organization
Organization Name:FALL CREEK MEDICAL MANAGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMOLENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-503-9000
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37065-1226
Mailing Address - Country:US
Mailing Address - Phone:615-591-2777
Mailing Address - Fax:615-591-2779
Practice Address - Street 1:120 WALNUT COMMONS LN
Practice Address - Street 2:STE D
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-6035
Practice Address - Country:US
Practice Address - Phone:931-520-8104
Practice Address - Fax:931-525-6107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty