Provider Demographics
NPI:1194923029
Name:LOBELVILLE CLINIC
Entity type:Organization
Organization Name:LOBELVILLE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MGR
Authorized Official - Phone:931-593-2277
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:236 NORTH MAIN ST.
Mailing Address - City:LOBELVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37097-0219
Mailing Address - Country:US
Mailing Address - Phone:931-593-2277
Mailing Address - Fax:931-593-2517
Practice Address - Street 1:236 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:LOBELVILLE
Practice Address - State:TN
Practice Address - Zip Code:37097
Practice Address - Country:US
Practice Address - Phone:931-593-2277
Practice Address - Fax:931-593-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3303612Medicaid
TN3303612Medicare ID - Type UnspecifiedLOBELVILLE CLINIC
TN3301352Medicare ID - Type UnspecifiedDR. KENNETH SALHANY
TN3303612Medicaid