Provider Demographics
NPI:1679677199
Name:CRIPPS, HOOPER & RHODY, PLLC
Entity Type:Organization
Organization Name:CRIPPS, HOOPER & RHODY, PLLC
Other - Org Name:FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-597-4395
Mailing Address - Street 1:302 N CONGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-2704
Mailing Address - Country:US
Mailing Address - Phone:615-597-4395
Mailing Address - Fax:615-597-5075
Practice Address - Street 1:302 N CONGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-2704
Practice Address - Country:US
Practice Address - Phone:615-597-4395
Practice Address - Fax:615-597-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724068Medicaid
TN44D0678624OtherCLIA NUMBER
TN3724068Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
TN1046170001Medicare NSC