Healthcare Provider Details

I. General information

NPI: 1366112732
Provider Name (Legal Business Name): MASON HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12173 MAIN ST STE B
MASON TN
38049-7067
US

IV. Provider business mailing address

12173 MAIN ST STE B
MASON TN
38049-7067
US

V. Phone/Fax

Practice location:
  • Phone: 901-283-8479
  • Fax:
Mailing address:
  • Phone: 901-283-8479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TIFFANY TAYLOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 901-283-8479