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General NPI Number Information
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NPI Number | 1518192582
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Entity Type | Organization
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Legal Business Name | WOBEGONE, INC.
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 355 NEW SHACKLE ISLAND ROAD EMERGENCY DEPARTMENT
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2300
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Country | US
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Telephone | 615-338-1258
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Fax | 615-338-1251
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Provider Business Mailing Address
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Address Line | P.O. BOX 2019
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City | MADISON
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State | TN
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Zip | 37116-2019
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Country | US
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Telephone | 615-860-8822
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Fax | 615-865-7598
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DUANE E. HARRISON
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Credential | M.D.
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Telephone | 615-860-8822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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