Provider Demographics
NPI:1811196066
Name:FAMILY HEALTH CARE OF CAMDEN, INC
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE OF CAMDEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CANNADY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-584-3330
Mailing Address - Street 1:350 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1650
Mailing Address - Country:US
Mailing Address - Phone:731-584-3330
Mailing Address - Fax:731-584-3332
Practice Address - Street 1:350 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1650
Practice Address - Country:US
Practice Address - Phone:731-584-3330
Practice Address - Fax:731-584-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6264261QR1300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720512Medicaid
TN3720512Medicaid