Healthcare Provider Details

I. General information

NPI: 1720703291
Provider Name (Legal Business Name): LANDMARK MEDICAL OF TENNESSEE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WASHINGTON AVE STE 201-220
SANTA FE NM
87501-2073
US

IV. Provider business mailing address

7755 CENTER AVE STE 630
HUNTINGTON BEACH CA
92647-9152
US

V. Phone/Fax

Practice location:
  • Phone: 657-400-5180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DENNIS
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 657-400-5180