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General NPI Number Information
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NPI Number | 1992191951
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Entity Type | Organization
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Legal Business Name | RED BUD REGIONAL CLINIC COMPANY LLC
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 509 HAMACHER ST SUITE 103
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City | WATERLOO
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State | IL
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Zip | 62298-1592
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Country | US
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Telephone | 618-939-2273
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Fax | 618-939-0245
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Provider Business Mailing Address
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Address Line | 1573 MALLORY LN STE 100
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City | BRENTWOOD
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State | TN
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Zip | 37027-2895
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Country | US
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Telephone | 615-221-1400
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Fax | 615-846-4988
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Authorized Official
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Title or Position | SR. DIRECTOR PHYSICIAN REV CYCLE
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Name | LAURA J FEY
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Credential |
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Telephone | 615-221-3641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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