MEDICARE: PATRICIA RENEE OBI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	017895	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	621861114	OTHER	TN	TAX ID

General Provider Information

NPI Number	:	1043213150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA RENEE OBI MD

Provider Business Mailing Address
First Line	:	168 W UNIVERSITY PKWY
Second Line	:	STE A&B
City	:	JACKSON
State	:	TN
Zip	:	38305-1624
Country	:	US
Telephone Number	:	731-512-0043
Fax Number	:	731-512-0015

Provider Business Practice Location Address
First Line	:	168 W UNIVERSITY PKWY
Second Line	:	STE A&B
City	:	JACKSON
State	:	TN
Zip	:	38305-1624
Country	:	US
Telephone Number	:	731-512-0043
Fax Number	:	731-512-0015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/18/2010

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