Provider Demographics
NPI:1649226606
Name:AMBULATORY AND OCCUPATIONAL HEALTH CLINIC PC
Entity Type:Organization
Organization Name:AMBULATORY AND OCCUPATIONAL HEALTH CLINIC PC
Other - Org Name:DOCTORSCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-645-1564
Mailing Address - Street 1:2320 WILMA RUDOLPH BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5821
Mailing Address - Country:US
Mailing Address - Phone:931-645-1564
Mailing Address - Fax:931-645-3842
Practice Address - Street 1:2320 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5821
Practice Address - Country:US
Practice Address - Phone:931-645-1564
Practice Address - Fax:931-645-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
7403392OtherAETNA
174664OtherHEALTHSPRING
=========OtherHUMANA
=========OtherSIGNATURE HEALTH ALLIANCE
=========OtherTRICARE
=========OtherPHCS
7403392OtherAETNA
3376221Medicare ID - Type Unspecified