Provider Demographics
NPI:1629295316
Name:THE FARM PRIMARY HEALTH CARE CLINIC
Entity Type:Organization
Organization Name:THE FARM PRIMARY HEALTH CARE CLINIC
Other - Org Name:THE FARM CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY, TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:931-964-2293
Mailing Address - Street 1:198 SECOND ROAD
Mailing Address - Street 2:48 THE FARM
Mailing Address - City:SUMMERTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38483
Mailing Address - Country:US
Mailing Address - Phone:931-964-2293
Mailing Address - Fax:931-964-4892
Practice Address - Street 1:198 SECOND ROAD
Practice Address - Street 2:48 THE FARM
Practice Address - City:SUMMERTOWN
Practice Address - State:TN
Practice Address - Zip Code:38483
Practice Address - Country:US
Practice Address - Phone:931-964-2293
Practice Address - Fax:931-964-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPM0000000004176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty