Provider Demographics
NPI:1255406450
Name:BRADSHAW MEDICAL CLINIC, PC
Entity type:Organization
Organization Name:BRADSHAW MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-444-4126
Mailing Address - Street 1:1409 W. BADDOUR PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2599
Mailing Address - Country:US
Mailing Address - Phone:615-444-4126
Mailing Address - Fax:615-547-1825
Practice Address - Street 1:1409 W. BADDOUR PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2599
Practice Address - Country:US
Practice Address - Phone:615-444-4126
Practice Address - Fax:615-547-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN4167261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717064Medicare PIN