MEDICARE: HOME PHYSICIANS 2011, PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	213E00000X	Podiatrist
3	363A00000X	Physician Assistant
4	363L00000X	Nurse Practitioner
5	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1417235359
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME PHYSICIANS 2011, PC

Provider Business Mailing Address
First Line	:	730 COOL SPRINGS BLVD STE 500
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7331
Country	:	US
Telephone Number	:	773-292-4800
Fax Number	:	312-564-4059

Provider Business Practice Location Address
First Line	:	525 W MONROE ST STE 1650
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-3647
Country	:	US
Telephone Number	:	773-292-4800
Fax Number	:	312-564-4059

Authorized Official
Title or Position	:	CREDENTIALING SR. MANAGER
Name	:	GRACE BLUE
Credential	:
Telephone Number	:	773-292-4800

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	03/20/2025

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