| Clinica Hispana, PLLC | |
|
301 Wolverine Trl Ste 202 Smyrna TN 37167-5656 | |
| (573) 880-0593 | |
| Not Available |
| Full Name | Clinica Hispana, PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 301 Wolverine Trl Ste 202, Smyrna, Tennessee |
| Authorized Official Name and Position | Tammy Bradley (PRACTICE MANAGER) |
| Authorized Official Contact | 6152810553 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Hispana, PLLC 301 Wolverine Trl Ste 202 Smyrna TN 37167-5656 Ph: (573) 880-0593 | Clinica Hispana, PLLC 301 Wolverine Trl Ste 202 Smyrna TN 37167-5656 Ph: (573) 880-0593 |
| NPI Number | 1235801176 |
|---|---|
| Provider Enumeration Date | 09/29/2021 |
| Last Update Date | 09/29/2021 |
| Certification Date | 09/29/2021 |
| Medicare PECOS PAC ID | 4385034990 |
|---|---|
| Medicare Enrollment ID | O20211214000124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235801176 | NPI | - | NPPES |
| 1588858567 | Other | TN | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Edmundo Humberto Yibirin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1588858567 PECOS PAC ID: 8921173980 Enrollment ID: I20180829004837 |
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