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General NPI Number Information
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NPI Number | 1659447696
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Entity Type | Organization
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Legal Business Name | BROWNSVILLE MEDICAL CLINIC, P.A.
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | 2565 N WASHINGTON AVE
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City | BROWNSVILLE
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State | TN
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Zip | 38012-1610
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Country | US
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Telephone | 731-772-4199
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Fax | 731-772-7703
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Provider Business Mailing Address
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Address Line | 2565 N WASHINGTON AVE
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City | BROWNSVILLE
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State | TN
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Zip | 38012-1610
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Country | US
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Telephone | 731-772-4199
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Fax | 731-772-7703
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CLAUDIA WHITE
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Credential |
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Telephone | 731-772-4199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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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 | MD8895
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License Number State | TN
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