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General NPI Number Information
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NPI Number | 1841311529
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Entity Type | Organization
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Legal Business Name | CITIZENS OF LAKE COUNTY FOR HEALTH CARE INC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 710 CARL PERKINS PKWY
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City | TIPTONVILLE
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State | TN
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Zip | 38079
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Country | US
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Telephone | 731-253-6690
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Fax | 731-253-6692
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Provider Business Mailing Address
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Address Line | 710 CARL PERKINS PKWY
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City | TIPTONVILLE
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State | TN
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Zip | 38079
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Country | US
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Telephone | 731-253-6690
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Fax | 731-253-6692
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Authorized Official
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Title or Position | FINANCIAL OFFICER
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Name | MRS. AMBER MARIE ISBELL
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Credential |
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Telephone | 731-253-6690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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