FAMILY CLINIC AT THE LAKE PLLC; NPI #1578125647

Contact Information

FAMILY CLINIC AT THE LAKE PLLC

11268 HIGHWAY 57
COUNCE, TN 38326-3802

Phone: 731-689-4357
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Rural Health	261QR1300X	B4[14]	Rural Health Clinic
Nurse Practitioner	363L00000X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for FAMILY CLINIC AT THE LAKE PLLC

NPI Number	`1578125647`
LBN Legal business name	FAMILY CLINIC AT THE LAKE PLLC
Authorized official	ELLANIKOLE JACKSON - (OWNER)
Entity	Organization
Organization subpart ¹	No
Enumeration date	06/28/2019
Last updated	10/14/2019 - About 7 years ago
Identifiers	n/a

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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FAMILY CLINIC AT THE LAKE PLLC

Contact Information

Specialty

Rural Health

Nurse Practitioner

NPI Profile & details for FAMILY CLINIC AT THE LAKE PLLC

Reviews for FAMILY CLINIC AT THE LAKE PLLC