Provider Demographics
NPI:1699012716
Name:FAMILY HEALTH CARE OF HENDERSONVILLE, PLLC
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE OF HENDERSONVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:DALLAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-826-3100
Mailing Address - Street 1:211 INDIAN LAKE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6442
Mailing Address - Country:US
Mailing Address - Phone:615-826-3100
Mailing Address - Fax:615-447-1060
Practice Address - Street 1:211 INDIAN LAKE BLVD STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6442
Practice Address - Country:US
Practice Address - Phone:615-826-3100
Practice Address - Fax:615-447-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374461Medicaid