Healthcare Provider Details

I. General information

NPI: 1033271812
Provider Name (Legal Business Name): ALAMO FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 N BELLS ST
ALAMO TN
38001-1767
US

IV. Provider business mailing address

157 NORTH BELLS STREET
ALAMO TN
38001
US

V. Phone/Fax

Practice location:
  • Phone: 731-696-5551
  • Fax: 731-696-2802
Mailing address:
  • Phone: 731-696-5551
  • Fax: 731-696-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4576973
License Number StateTN

VIII. Authorized Official

Name: DR. RONALD C TILLMAN
Title or Position: MD OWNER
Credential: M.D.
Phone: 731-696-5551