Provider Demographics
NPI:1023228244
Name:BRISTOL FAMILY MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:BRISTOL FAMILY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BROADUS
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:BEESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-968-5225
Mailing Address - Street 1:28 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1706
Mailing Address - Country:US
Mailing Address - Phone:423-968-5225
Mailing Address - Fax:423-764-8274
Practice Address - Street 1:28 MIDWAY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1706
Practice Address - Country:US
Practice Address - Phone:423-968-5225
Practice Address - Fax:423-764-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty