=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811392145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACUTE CARE CLNIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2014
-----------------------------------------------------
Last Update Date | 07/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 S WEBB AVE
-----------------------------------------------------
City | CROSSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38555-8452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-484-5379
-----------------------------------------------------
Fax | 931-484-5946
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 131 S WEBB AVE
-----------------------------------------------------
City | CROSSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38555-8452
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-484-5379
-----------------------------------------------------
Fax | 931-484-5946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JILL K DENNEY
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 931-484-5379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------