Healthcare Provider Details

I. General information

NPI: 1114973237
Provider Name (Legal Business Name): RUTHERFORD COUNTY PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 HOPE WAY
MURFREESBORO TN
37129-3140
US

IV. Provider business mailing address

1453 HOPE WAY
MURFREESBORO TN
37129-3140
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-9390
  • Fax: 615-893-4162
Mailing address:
  • Phone: 615-893-9390
  • Fax: 615-893-4162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANE SMITH
Title or Position: FINANCIAL OFFICER
Credential:
Phone: 615-893-9390