MEDICARE: CLARKSVILLE PHYSICIAN SERVICES, LLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	44-8914	OTHER	TN	TN-MEDICARE PART A

General Provider Information

NPI Number	:	1992077077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARKSVILLE PHYSICIAN SERVICES, LLC

Provider Business Mailing Address
First Line	:	3841 GREEN HILLS VILLAGE DR STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 DR ROBERT H LEE ROAD
Second Line	:
City	:	DOVER
State	:	TN
Zip	:	37058-3750
Country	:	US
Telephone Number	:	931-232-5141
Fax Number	:	931-232-3905

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WENDY MONACI
Credential	:
Telephone Number	:	615-936-3944

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	02/03/2026

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