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General NPI Number Information
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NPI Number | 1396321410
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Entity Type | Organization
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Legal Business Name | TEN BROECK TENNESSEE PHYSICIANS GROUP INC
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Dates
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Enumeration Date | 03/19/2021
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 2 S HOSPITAL DR
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City | MURPHYSBORO
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State | IL
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Zip | 62966-3333
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Country | US
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Telephone | 618-684-3156
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Fax | 618-684-1024
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Provider Business Mailing Address
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Address Line | 603 MAIN ST
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City | WINDERMERE
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State | FL
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Zip | 34786-3548
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Country | US
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Telephone | 407-876-2200
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Fax |
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Authorized Official
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Title or Position | DIRECTOR COMPLIANCE
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Name | GLENDA F GUY
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Credential |
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Telephone | 931-607-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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