Provider Demographics
NPI:1750456414
Name:MID -TENNESSEE FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:MID -TENNESSEE FAMILY HEALTH CENTER
Other - Org Name:MID-TENNESSE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:931-766-5001
Mailing Address - Street 1:110 WEAKLEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2238
Mailing Address - Country:US
Mailing Address - Phone:931-766-5001
Mailing Address - Fax:931-762-3800
Practice Address - Street 1:110 WEAKLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2238
Practice Address - Country:US
Practice Address - Phone:931-766-5001
Practice Address - Fax:931-762-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3712106Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TNCG1817Medicare ID - Type UnspecifiedRR MEDICARE NUMBER