| Family Medical Clinic Of Trezevant | |
|
45 Hurt St Trezevant TN 38258-2505 | |
| (731) 207-0323 | |
| (731) 240-8065 |
| Full Name | Family Medical Clinic Of Trezevant |
|---|---|
| Speciality | Clinic/Center |
| Location | 45 Hurt St, Trezevant, Tennessee |
| Authorized Official Name and Position | Deborah Kay Leggett (OWNER) |
| Authorized Official Contact | 7312003001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medical Clinic Of Trezevant 45 Hurt St Trezevant TN 38258-2505 Ph: (731) 207-0323 | Family Medical Clinic Of Trezevant 45 Hurt St Trezevant TN 38258-2505 Ph: (731) 207-0323 |
| NPI Number | 1538703897 |
|---|---|
| Provider Enumeration Date | 10/30/2019 |
| Last Update Date | 03/31/2022 |
| Medicare PECOS PAC ID | 2860828936 |
|---|---|
| Medicare Enrollment ID | O20200210000066 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538703897 | NPI | - | NPPES |
| Q054230 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Tammy M Griffis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407251267 PECOS PAC ID: 8820310824 Enrollment ID: I20141202001405 |
| Provider Name | Deborah Leggett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528442688 PECOS PAC ID: 5496055600 Enrollment ID: I20151119001750 |
| Provider Name | Cynthia Hinson Carroll |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700367091 PECOS PAC ID: 9436588423 Enrollment ID: I20200325003866 |
| Provider Name | Rhiannon Michelle Andresen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831750843 PECOS PAC ID: 0648699439 Enrollment ID: I20200928002684 |