| Brookside Medical Center Pllc | |
|
5121 Ooltewah Ringgold Road Suite G Collegedale TN 37315 | |
| (423) 238-0033 | |
| Not Available |
| Full Name | Brookside Medical Center Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 5121 Ooltewah Ringgold Road, Collegedale, Tennessee |
| Authorized Official Name and Position | Shirley Spears (ADMINISTRATOR) |
| Authorized Official Contact | 4232380033 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Brookside Medical Center Pllc Po Box 793 Ooltewah TN 37363-0793 Ph: (423) 238-0033 | Brookside Medical Center Pllc 5121 Ooltewah Ringgold Road Suite G Collegedale TN 37315 Ph: (423) 238-0033 |
| NPI Number | 1083637078 |
|---|---|
| Provider Enumeration Date | 07/25/2006 |
| Last Update Date | 11/30/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083637078 | NPI | - | NPPES |
| 3735307 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |