MCKENZIE MEDICAL CENTER PC; NPI #1477516953

Contact Information

MCKENZIE MEDICAL CENTER PC

205A HOSPITAL DR
MCKENZIE, TN 38201-1649

Phone: 731-352-7907
Fax: 833-690-3848
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Rural Health	261QR1300X	B4[14]	Rural Health Clinic
Clinical	1041C0700X	80	Licensed Clinical Social Worker
Family	363LF0000X	50	Nurse Practitioner
Internal Medicine	207R00000X	11	Physician/Internal Medicine
Marriage & Family Therapist	106H00000X
Optometrist	152W00000X	41	Optometry
Pediatrics	208000000X	37	Physician/Pediatric Medicine
Physician Assistant	363A00000X	97	Physician Assistant
Psychiatric/Mental Health	363LP0808X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for MCKENZIE MEDICAL CENTER PC

NPI # 1477516953

LBN Legal business name MCKENZIE MEDICAL CENTER PC

Authorized official TAMMY ETHERIDGE - (CHIEF OPERATING OFFICER)

Entity Organization

Organization subpart ¹ No

Enumeration date 04/07/2006

Last updated 12/03/2024 - More than a year ago

Identifiers

TN	License #	APN6244
TN	License #	LMFT917
TN	License #	LSW5620
TN	License #	MD15682
TN	License #	MD46412
TN	License #	ODT441
TN	License #	PA1503
TN	Other	3380640	GROUP MEDICAID
TN	Other	3380640	GROUP MEDICARE

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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MCKENZIE MEDICAL CENTER PC

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NPI Profile & details for MCKENZIE MEDICAL CENTER PC

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