Provider Demographics
NPI:1760859441
Name:MEDWORKS OF TULLAHOMA PC
Entity Type:Organization
Organization Name:MEDWORKS OF TULLAHOMA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TINCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-222-4626
Mailing Address - Street 1:106 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3556
Mailing Address - Country:US
Mailing Address - Phone:931-222-4626
Mailing Address - Fax:
Practice Address - Street 1:106 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3556
Practice Address - Country:US
Practice Address - Phone:931-222-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN462972083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicaid
TNPENDINGMedicaid