Healthcare Provider Details

I. General information

NPI: 1487364709
Provider Name (Legal Business Name): ACUTE CARE CLINIC CLARKRANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 S YORK HWY
CLARKRANGE TN
38553-5102
US

IV. Provider business mailing address

100 S DUNCAN ST
JAMESTOWN TN
38556-3009
US

V. Phone/Fax

Practice location:
  • Phone: 931-863-5095
  • Fax: 931-863-3530
Mailing address:
  • Phone: 931-863-5095
  • Fax: 931-863-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMARA EROH
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 931-200-2246