Healthcare Provider Details

I. General information

NPI: 1457302598
Provider Name (Legal Business Name): FAMILY CARE WALK IN CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date: 05/17/2023
Reactivation Date: 06/22/2023

III. Provider practice location address

176 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1618
US

IV. Provider business mailing address

176 W UNIVERSITY PKWY STE C
JACKSON TN
38305-1618
US

V. Phone/Fax

Practice location:
  • Phone: 731-660-6915
  • Fax: 731-668-4557
Mailing address:
  • Phone: 731-660-6915
  • Fax: 731-668-4557

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 Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY BEUERLEIN
Title or Position: OWNER
Credential:
Phone: 731-660-6915