Provider Demographics
NPI:1891034021
Name:MARTIN METHODIST CLINIC
Entity Type:Organization
Organization Name:MARTIN METHODIST CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MDIV, PHD
Authorized Official - Phone:931-363-9802
Mailing Address - Street 1:433 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-2716
Mailing Address - Country:US
Mailing Address - Phone:931-363-9800
Mailing Address - Fax:931-363-9818
Practice Address - Street 1:625 W MADISON ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-2611
Practice Address - Country:US
Practice Address - Phone:931-424-7338
Practice Address - Fax:931-424-7341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTIN METHODIST COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-07
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health