Provider Demographics
NPI:1760939516
Name:WARTBURG AMBULATORY CARE
Entity Type:Organization
Organization Name:WARTBURG AMBULATORY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-879-5864
Mailing Address - Street 1:1236 KNOXVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-4200
Mailing Address - Country:US
Mailing Address - Phone:423-346-5566
Mailing Address - Fax:
Practice Address - Street 1:1236 KNOXVILLE HWY
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4200
Practice Address - Country:US
Practice Address - Phone:423-346-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNF06162314261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care