MEDICARE: MCNAIRY CLINIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	261Q00000X	Clinic/Center
2	207R00000X	Internal Medicine Physician	TN
3	363L00000X	Nurse Practitioner	TN
4	207V00000X	Obstetrics & Gynecology Physician
5	207Q00000X	Family Medicine Physician	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386692606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCNAIRY CLINIC CORP

Provider Business Mailing Address
First Line	:	7100 COMMERCE WAY
Second Line	:	SUITE 180
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2829
Country	:	US
Telephone Number	:	615-465-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 E POPLAR AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-1828
Country	:	US
Telephone Number	:	731-646-0181
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DEBBIE T BREWER
Credential	:
Telephone Number	:	615-465-7626

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	10/14/2008

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Practice Location Address:

705 E POPLAR AVE
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Directions to “MCNAIRY CLINIC CORP ” Practice Location

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