Provider Demographics
NPI:1982922316
Name:LIFETIME FAMILY HEALTH CLINIC
Entity Type:Organization
Organization Name:LIFETIME FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ARNS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:423-626-0300
Mailing Address - Street 1:PO BOX 1588
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37824-1588
Mailing Address - Country:US
Mailing Address - Phone:423-626-0300
Mailing Address - Fax:423-626-0314
Practice Address - Street 1:2255 HIGHWAY 25E
Practice Address - Street 2:SUITE 2
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3857
Practice Address - Country:US
Practice Address - Phone:423-626-0300
Practice Address - Fax:423-626-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty