Healthcare Provider Details

I. General information

NPI: 1518238740
Provider Name (Legal Business Name): MADISON STREET FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MADISON ST SUITE A
SHELBYVILLE TN
37160-3629
US

IV. Provider business mailing address

1401 MADISON ST SUITE A
SHELBYVILLE TN
37160-3629
US

V. Phone/Fax

Practice location:
  • Phone: 931-685-2022
  • Fax:
Mailing address:
  • Phone: 931-685-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29483
License Number StateTN

VIII. Authorized Official

Name: MR. RODNEY PARSONS
Title or Position: OWNER
Credential:
Phone: 931-685-2022