Provider Demographics
NPI:1952561979
Name:WARTRACE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:WARTRACE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-685-2022
Mailing Address - Street 1:1612 N MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2391
Mailing Address - Country:US
Mailing Address - Phone:931-685-2022
Mailing Address - Fax:931-685-4158
Practice Address - Street 1:507 BLACKMAN BLVD W
Practice Address - Street 2:
Practice Address - City:WARTRACE
Practice Address - State:TN
Practice Address - Zip Code:37183-2210
Practice Address - Country:US
Practice Address - Phone:931-389-0600
Practice Address - Fax:931-389-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000029483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN443969Medicare Oscar/Certification
TN3370379Medicare PIN