Provider Demographics
NPI:1992077077
Name:CLARKSVILLE PHYSICIAN SERVICES GP
Entity type:Organization
Organization Name:CLARKSVILLE PHYSICIAN SERVICES GP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEOPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7000
Mailing Address - Street 1:PO BOX 8574
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8574
Mailing Address - Country:US
Mailing Address - Phone:877-848-1463
Mailing Address - Fax:
Practice Address - Street 1:133 DR ROBERT H LEE DRIVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3750
Practice Address - Country:US
Practice Address - Phone:888-304-1079
Practice Address - Fax:615-469-6629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARKSVILLE PHYSICIAN SERVICES GP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-03
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN44-8914OtherTN-MEDICARE PART A