Healthcare Provider Details

I. General information

NPI: 1639491616
Provider Name (Legal Business Name): ENTERPRISE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BRUNSON ST STE 300
ENTERPRISE AL
36330-2500
US

IV. Provider business mailing address

7100 COMMERCE WAY STE 180
BRENTWOOD TN
37027-2829
US

V. Phone/Fax

Practice location:
  • Phone: 332-393-3212
  • Fax:
Mailing address:
  • Phone: 615-465-7000
  • Fax: 615-465-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA MUSIC
Title or Position: DIRECTOR, PROVIDER ENROLLMENT
Credential:
Phone: 877-892-9815