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NPI Code Detail

MEDICARE: SHELBYVILLE CLINIC CORP

MEDICARE: SHELBYVILLE CLINIC CORP
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
1207R00000XInternal Medicine Physician
2207V00000XObstetrics & Gynecology Physician
3207X00000XOrthopaedic Surgery Physician
4208000000XPediatrics Physician
5208600000XSurgery Physician
6208M00000XHospitalist Physician
7363L00000XNurse PractitionerTN
8207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13732391OTHERTNBCBS

General Provider Information

NPI Number : 1295785699
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHELBYVILLE CLINIC CORP
Provider Business Mailing Address
First Line : 2839 HIGHWAY 231 N STE 100
Second Line :
City : SHELBYVILLE
State : TN
Zip : 37160-7448
Country : US
Telephone Number : 931-685-8770
Fax Number : 931-685-8771
Provider Business Practice Location Address
First Line : 2835 HIGHWAY 231 N STE 100
Second Line :
City : SHELBYVILLE
State : TN
Zip : 37160-7327
Country : US
Telephone Number : 931-685-8770
Fax Number : 931-685-8771
Authorized Official
Title or Position : VP PHYSICIAN BUSINESS SERVICES
Name : JAMES P WRIGHT
Credential :
Telephone Number : 615-778-1502
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/26/2019

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1669558417 — JAMES R PARNELL CRNA
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1457508160 — CHARLES E KELLY II MD
Practice Location Address:
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Directions to “SHELBYVILLE CLINIC CORP ” Practice Location

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