Provider Demographics
NPI:1578179230
Name:CYRUS FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:CYRUS FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARAMARZ
Authorized Official - Middle Name:
Authorized Official - Last Name:GHANBARI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-651-0017
Mailing Address - Street 1:503 WESTFIELD PL
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-5144
Mailing Address - Country:US
Mailing Address - Phone:423-651-0300
Mailing Address - Fax:423-651-0017
Practice Address - Street 1:503 WESTFIELD PL
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-5144
Practice Address - Country:US
Practice Address - Phone:423-651-0300
Practice Address - Fax:423-651-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty