Provider Demographics
NPI:1013048792
Name:COMMUNITY MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-735-8040
Mailing Address - Street 1:619 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1259
Mailing Address - Country:US
Mailing Address - Phone:615-735-8040
Mailing Address - Fax:615-735-8048
Practice Address - Street 1:619 MAIN ST N
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1259
Practice Address - Country:US
Practice Address - Phone:615-735-8040
Practice Address - Fax:615-735-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care