=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053548487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE STOP MEDICAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2009
-----------------------------------------------------
Last Update Date | 05/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 326 N LOCUST AVE
-----------------------------------------------------
City | LAWRENCEBURG
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38464-3516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-762-9797
-----------------------------------------------------
Fax | 931-762-9798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 191
-----------------------------------------------------
City | LAWRENCEBURG
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38464-0191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-762-9797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | JUDY C LONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 931-424-9797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------