Provider Demographics
NPI:1285612564
Name:CAMDEN MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:CAMDEN MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-279-0600
Mailing Address - Street 1:160 HOSPITAL DR.
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320
Mailing Address - Country:US
Mailing Address - Phone:731-279-0600
Mailing Address - Fax:731-279-0555
Practice Address - Street 1:160 HOSPITAL DR.
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320
Practice Address - Country:US
Practice Address - Phone:731-279-0600
Practice Address - Fax:731-279-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006407261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727780Medicaid
44D0984486OtherCLIA NUMBER
44D0984486OtherCLIA NUMBER
TN3727780Medicare ID - Type Unspecified