MEDICARE: BROWNSVILLE MEDICAL CLINIC, P.A.

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	261QP2300X	Primary Care Clinic/Center	MD8895	TN
2	174400000X	Specialist

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508916206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWNSVILLE MEDICAL CLINIC, P.A.

Provider Business Mailing Address
First Line	:	3363 N HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3487
Country	:	US
Telephone Number	:	731-660-6828
Fax Number	:	731-660-6820

Provider Business Practice Location Address
First Line	:	3363 N HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3487
Country	:	US
Telephone Number	:	731-660-6828
Fax Number	:	731-660-6820

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CLAUDIA WHITE
Credential	:
Telephone Number	:	731-660-6828

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/09/2010

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