MEDICARE: WT MEDICAL ASSOCIATES

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1356176556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WT MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	320 S CHURCH ST
Second Line	:
City	:	HALLS
State	:	TN
Zip	:	38040-1510
Country	:	US
Telephone Number	:	731-836-9303
Fax Number	:	731-836-9603

Provider Business Practice Location Address
First Line	:	320 S CHURCH ST
Second Line	:
City	:	HALLS
State	:	TN
Zip	:	38040-1510
Country	:	US
Telephone Number	:	731-836-9303
Fax Number	:	731-836-9603

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MS. TINA PRESCOTT
Credential	:
Telephone Number	:	731-541-5000

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	10/14/2024

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Directions to “WT MEDICAL ASSOCIATES ” Practice Location

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