MEDICARE: CEDARS HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	RN0101110	TN
2	261QH0100X	Health Service Clinic/Center	APN7024	TN

General Provider Information

NPI Number	:	1942520713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDARS HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 415
Second Line	:
City	:	NEW MARKET
State	:	TN
Zip	:	37820-0415
Country	:	US
Telephone Number	:	865-475-6100
Fax Number	:	865-475-6106

Provider Business Practice Location Address
First Line	:	1004 N HIGHWAY 92
Second Line	:	SUITE C
City	:	JEFFERSON CITY
State	:	TN
Zip	:	37760-3687
Country	:	US
Telephone Number	:	865-475-6100
Fax Number	:	865-475-6106

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BARBARA J SMITH
Credential	:	MSN, RN, FNP-BC
Telephone Number	:	865-803-5717

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/03/2010

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Directions to “CEDARS HEALTHCARE LLC ” Practice Location

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