MEDICARE: LANDMARK MEDICAL OF TENNESSEE PC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1720703291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDMARK MEDICAL OF TENNESSEE PC

Provider Business Mailing Address
First Line	:	7755 CENTER AVE STE 630
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-9152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 WASHINGTON AVE STE 201-220
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-2073
Country	:	US
Telephone Number	:	657-400-5180
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	CHRISTOPHER DENNIS
Credential	:
Telephone Number	:	657-400-5180

Provider Enumeration Date	:	10/07/2022
Last Update Date	:	01/30/2024

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