Healthcare Provider Details

I. General information

NPI: 1922332428
Provider Name (Legal Business Name): WHITE COUNTY PHYSICIAN SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SEWELL DR
SPARTA TN
38583-1223
US

IV. Provider business mailing address

401 SEWELL DR
SPARTA TN
38583-1223
US

V. Phone/Fax

Practice location:
  • Phone: 931-738-4347
  • Fax: 931-738-9236
Mailing address:
  • Phone: 931-738-4347
  • Fax: 931-738-9236

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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL S SLIPKOVICH
Title or Position: CEO
Credential:
Phone: 615-764-3049