Provider Demographics
NPI:1588851661
Name:PHYSICIANS MEDICAL CARE
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-217-7236
Mailing Address - Street 1:1525 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-5510
Mailing Address - Country:US
Mailing Address - Phone:615-217-7236
Mailing Address - Fax:615-217-7238
Practice Address - Street 1:1525 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-5510
Practice Address - Country:US
Practice Address - Phone:615-217-7236
Practice Address - Fax:615-217-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3715745Medicare PIN