MCKENZIE MEDICAL CENTER PC NPI 1609101534

NPI Information

NPI: 1609101534
Provider Name: MCKENZIE MEDICAL CENTER, PC

Doing Business As: HOMETOWN HEALTH CLINIC

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
136 S. WILSON STREET
DRESDEN, TN
ZIP 38255
Phone: (731) 364-4900
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MCKENZIE MEDICAL CENTER, PC is a rural health clinic center in Dresden, TN. MCKENZIE MEDICAL CENTER, PC NPI is 1609101534. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Hometown Health Clinic.

The provider's business location address is:

136 S. WILSON STREET
DRESDEN, TN
ZIP 38255
Phone: (731) 364-4900
Fax: (731) 352-4459

The provider's authorized official is Tammy Etheridge .
The authorized official title is Chief Operating Officer and has the following contact phone number (731) 352-7907.

The CLIA number assigned to this NPI record is 44D0902258 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/9/2009 and was last updated on 3/12/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	152W00000X	Optometrist		ODT1599	TENNESSEE	No
2	207Q00000X	Family Medicine		MD23833	TENNESSEE	No
3	261Q00000X	Clinic/Center				No
4	261QR1300X	Clinic/Center	Rural Health			Yes
5	363A00000X	Physician Assistant		PA1262	TENNESSEE	No
6	363LF0000X	Nurse Practitioner	Family	APN14751	TENNESSEE	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3380640	OTHER	TENNESSEE	GROUP MEDICARE NUMBER
2	Q018764	MEDICAID	TENNESSEE
3	3380640	OTHER	TENNESSEE	GROUP MEDICAID NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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