Provider Demographics
NPI:1831703933
Name:LANDMARK HEALTHCARE
Entity type:Organization
Organization Name:LANDMARK HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-347-9125
Mailing Address - Street 1:1119 E COLLEGE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4564
Mailing Address - Country:US
Mailing Address - Phone:931-347-9125
Mailing Address - Fax:931-347-9127
Practice Address - Street 1:1119 E COLLEGE ST STE 3
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4564
Practice Address - Country:US
Practice Address - Phone:931-347-9125
Practice Address - Fax:931-347-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care