Provider Demographics
NPI:1124332697
Name:BEERSHEBA SPRINGS MEDICAL CLINIC
Entity type:Organization
Organization Name:BEERSHEBA SPRINGS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWELL
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-895-8847
Mailing Address - Street 1:2975 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2970
Mailing Address - Country:US
Mailing Address - Phone:502-895-8847
Mailing Address - Fax:
Practice Address - Street 1:19562 HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:BEERSHEBA SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37305
Practice Address - Country:US
Practice Address - Phone:931-692-3631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000015473261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center