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General NPI Number Information
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NPI Number | 1609101534
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Entity Type | Organization
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Legal Business Name | MCKENZIE MEDICAL CENTER, PC
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 811 MORROW ST STE 207
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City | DRESDEN
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State | TN
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Zip | 38225-1847
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Country | US
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Telephone | 731-364-4900
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Fax | 833-690-3848
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Provider Business Mailing Address
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Address Line | 205A HOSPITAL DR
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City | MC KENZIE
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State | TN
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Zip | 38201-1649
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Country | US
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Telephone | 731-352-7907
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Fax | 731-352-4459
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | TAMMY ETHERIDGE
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Credential |
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Telephone | 731-352-7907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | ODT1599
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD23833
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1262
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN14751
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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