Healthcare Provider Details

I. General information

NPI: 1467957126
Provider Name (Legal Business Name): ADVANCED FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MAIN ST N
MIDDLETON TN
38052-3433
US

IV. Provider business mailing address

101 MAIN ST N
MIDDLETON TN
38052-3433
US

V. Phone/Fax

Practice location:
  • Phone: 731-472-2147
  • Fax: 731-472-2148
Mailing address:
  • Phone: 731-472-2147
  • Fax: 731-472-2148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17787
License Number StateTN

VIII. Authorized Official

Name: WILLIAM V CAICEDO
Title or Position: NP
Credential: FNP
Phone: 731-518-7391