CITIZENS OF LAKE COUNTY FOR HEALTH CARE INC NPI 1841311529

NPI Information

CITIZENS OF LAKE COUNTY FOR HEALTH CARE INC is a federally qualified health center (fqhc) clinic center in Tiptonville, TN. CITIZENS OF LAKE COUNTY FOR HEALTH CARE INC NPI is 1841311529. The provider is registered as an organization entity type.
The provider Is Doing Business As Lake County Primary Care.

The provider's business location address is:

710 CARL PERKINS PKWY
TIPTONVILLE, TN
ZIP 38079
Phone: (731) 253-6690
Fax: (731) 253-6692

The provider's authorized official is Amber Marie Isbell .
The authorized official title is Financial Officer and has the following contact phone number (731) 253-6690.

The enumeration date for this NPI number is 4/2/2007 and was last updated on 11/6/2012.

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:

Other Identifiers

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

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