Provider Demographics
NPI:1942485784
Name:SHELBYVILLE CLINIC CORP
Entity Type:Organization
Organization Name:SHELBYVILLE CLINIC CORP
Other - Org Name:LAURENCE SCHWARTZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:4000 MERIDIAN BLVD
Mailing Address - Street 2:ATTN: DEBBIE BREWER
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6325
Mailing Address - Country:US
Mailing Address - Phone:877-892-9813
Mailing Address - Fax:615-465-3007
Practice Address - Street 1:2320 THORNTON TAYLOR PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3630
Practice Address - Country:US
Practice Address - Phone:931-438-5515
Practice Address - Fax:931-438-5516
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHELBYVILLE CLINIC CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies