Provider Demographics
NPI:1386951101
Name:THORNBURG FAMILY MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:THORNBURG FAMILY MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,FNP-BC
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:38320-1618
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:38320-1618
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:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14836261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care