Provider Demographics
NPI:1770523508
Name:LUTZ FAMILY CARE CLINIC, PLLC
Entity type:Organization
Organization Name:LUTZ FAMILY CARE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:PA-C
Authorized Official - Phone:931-582-8820
Mailing Address - Street 1:106 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MC EWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101-4590
Mailing Address - Country:US
Mailing Address - Phone:931-582-8820
Mailing Address - Fax:931-582-8970
Practice Address - Street 1:106 MAIN ST
Practice Address - Street 2:
Practice Address - City:MC EWEN
Practice Address - State:TN
Practice Address - Zip Code:37101-4590
Practice Address - Country:US
Practice Address - Phone:931-582-8820
Practice Address - Fax:931-582-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care