MEDICARE: DEBORAH VERBEEK

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	207Q00000X	Family Medicine Physician

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

General Provider Information

NPI Number	:	1194835645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEBORAH VERBEEK

Provider Business Mailing Address
First Line	:	25495 MAIN ST
Second Line	:
City	:	ARDMORE
State	:	TN
Zip	:	38449-3129
Country	:	US
Telephone Number	:	931-427-6969
Fax Number	:	931-427-6967

Provider Business Practice Location Address
First Line	:	25495 MAIN ST
Second Line	:
City	:	ARDMORE
State	:	TN
Zip	:	38449-3129
Country	:	US
Telephone Number	:	931-427-6969
Fax Number	:	931-427-6967

Authorized Official
Title or Position	:	OWNER
Name	:	DEBORAH R VERBEEK
Credential	:	CFNP
Telephone Number	:	931-427-6969

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/09/2010

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