National Provider Identifier Database

MCKENZIE MEDICAL CENTER PC
Rural Health


Contact Information

MCKENZIE MEDICAL CENTER, PC
105 N CEDAR ST
GLEASON, TN38229-7264
Phone: 731-648-5634
Fax: 833-690-3848
Website:
Specialty Taxonomy Code
* Rural Health 261QR1300X
Family 363LF0000X
Family Medicine 207Q00000X
Internal Medicine 207R00000X
Optometrist 152W00000X
Physician Assistant 363A00000X

* Indicates primary specialty

NPI Profile & details for MCKENZIE MEDICAL CENTER, PC

NPI Number 1225083991
Legal business name
LBN
MCKENZIE MEDICAL CENTER, PC
Authorized official TAMMY ETHERIDGE - (CHIEF OPERATING OFFICER)
Entity Organization
Organization subpart No
Enumeration date 05/23/2006
Last updated 05/06/2024 - About 2 years ago
Sole proprietor1 Not specified
Identifiers
  • TN License #: APN15541
  • TN License #: MD23833
  • TN License #: ODT1599
  • TN Medicaid: 3730458
  • TN Other: 3380640 GROUP MEDICAID
  • TN Other: 3380640 MEDICARE GROUP

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

Reviews for MCKENZIE MEDICAL CENTER, PC

There are currently no reviews for MCKENZIE MEDICAL CENTER, PC


NPIdb - Home
v2.201