Provider Demographics
NPI:1386285948
Name:TEN BROECK TENNESSEE PHYSICIANS
Entity type:Organization
Organization Name:TEN BROECK TENNESSEE PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-783-2511
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4294
Mailing Address - Country:US
Mailing Address - Phone:931-783-2511
Mailing Address - Fax:
Practice Address - Street 1:11110 WOODSON DRIVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-1053
Practice Address - Country:US
Practice Address - Phone:936-567-2273
Practice Address - Fax:936-567-2274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEN BROECK TENNESSEE PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-04
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)