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NPI Code Detail

MEDICARE: WARTBURG AMBULATORY CARE

MEDICARE: WARTBURG AMBULATORY CARE
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
1261QP2300XPrimary Care Clinic/CenterF06162314TN

General Provider Information

NPI Number : 1760939516
Entity Type Code : Organization
Provider Name (Legal Business Name) : WARTBURG AMBULATORY CARE
Provider Business Mailing Address
First Line : 1236 KNOXVILLE HWY
Second Line :
City : WARTBURG
State : TN
Zip : 37887-4200
Country : US
Telephone Number : 423-346-5566
Fax Number :
Provider Business Practice Location Address
First Line : 1236 KNOXVILLE HWY
Second Line :
City : WARTBURG
State : TN
Zip : 37887-4200
Country : US
Telephone Number : 423-346-5566
Fax Number :
Authorized Official
Title or Position : CHEIF DOCTOR
Name : DOUG SMITH
Credential : MD
Telephone Number : 931-879-5864
Provider Enumeration Date : 09/08/2016
Last Update Date : 09/08/2016

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Directions to “WARTBURG AMBULATORY CARE ” Practice Location

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