Provider Demographics
NPI:1801201520
Name:KENNETT HMA LLC
Entity Type:Organization
Organization Name:KENNETT HMA LLC
Other - Org Name:TWIN RIVERS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7587
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7000
Mailing Address - Fax:615-465-3007
Practice Address - Street 1:1231 1ST ST
Practice Address - Street 2:SUITE 5
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-2527
Practice Address - Country:US
Practice Address - Phone:573-888-8690
Practice Address - Fax:573-717-1085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNETT HMA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-23
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty