Provider Demographics
NPI:1831948504
Name:FREE MEDICAL CLINIC OF OAK RIDGE
Entity type:Organization
Organization Name:FREE MEDICAL CLINIC OF OAK RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSENGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-483-3904
Mailing Address - Street 1:116 E DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6906
Mailing Address - Country:US
Mailing Address - Phone:865-483-3094
Mailing Address - Fax:
Practice Address - Street 1:116 E DIVISION RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6906
Practice Address - Country:US
Practice Address - Phone:865-483-3904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental