Provider Demographics
NPI:1356405039
Name:CLARKSVILLE CARDIOLOGY P.C.
Entity type:Organization
Organization Name:CLARKSVILLE CARDIOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:931-648-0064
Mailing Address - Street 1:1731 MEMORIAL DR
Mailing Address - Street 2:STE
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4523
Mailing Address - Country:US
Mailing Address - Phone:931-648-0064
Mailing Address - Fax:931-553-4215
Practice Address - Street 1:1731 MEMORIAL DR
Practice Address - Street 2:STE
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4523
Practice Address - Country:US
Practice Address - Phone:931-648-0064
Practice Address - Fax:931-553-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20760207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3713545Medicare ID - Type Unspecified