| Michiel Brent Rudder, FNP MSW | |
|
622 West Market Street, Bolivar, TN 38008 | |
| (731) 658-4500 | |
| (731) 658-4545 |
| Full Name | Michiel Brent Rudder |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner |
| Experience | 24 Years |
| Location | 622 West Market Street, Bolivar, Tennessee |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841287109 | NPI | - | NPPES |
| 3909409 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | RN131561 (Tennessee) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Medical Center Home Health | Jackson, TN | Home health agency |
| Abilishealth Brownsville, Llc | Brownsville, TN | Home health agency |
| Jackson-madison County General Hospital | Jackson, TN | Hospital |
| Milan General Hospital | Milan, TN | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Physicians Quality Care Pllc | 4385728518 | 4 |
| Entity Name | Physicians Quality Care Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1528240256 PECOS PAC ID: 4385728518 Enrollment ID: O20080227000370 |
| Mailing Address | Practice Location Address |
|---|---|
| Michiel Brent Rudder, FNP MSW Po Box 11567, Jackson, TN 38308-0126 Ph: (731) 661-0086 | Michiel Brent Rudder, FNP MSW 622 West Market Street, Bolivar, TN 38008 Ph: (731) 658-4500 |
Judith Anne Tessema, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 629 Nuckolls Rd, Bolivar, TN 38008 Phone: 731-658-3388 | |
Dr. Robert Wayne Dunavant, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 610 Nuckolls Rd, Bolivar, TN 38008 Phone: 731-658-7111 Fax: 731-658-4328 | |
Dr. John Lee Blankenship, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 629 Nuckolls Rd, Bolivar, TN 38008 Phone: 731-658-3388 Fax: 731-658-4079 | |
Dr. Samuel Terry Johnson Jr., M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 629 Nuckolls Rd, Bolivar, TN 38008 Phone: 731-658-3388 Fax: 731-658-4079 | |
Lawrence Diaz, D.O. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 629 Nuckolls Rd, Bolivar, TN 38008 Phone: 731-658-3388 Fax: 731-658-4079 | |
Olufemi E Soyinka, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 629 Nuckolls Rd, Bolivar, TN 38008 Phone: 731-658-3388 Fax: 731-658-4079 | |
Dr. Nithyananda Pakkala, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 630 Nuckolls Rd, Bolivar, TN 38008 Phone: 731-658-6011 Fax: 731-658-9884 |