| Homer L. Staley, Md | |
|
104 N Locust Ave Lawrenceburg TN 38464-3734 | |
| (931) 762-6476 | |
| (931) 762-1841 |
| Full Name | Homer L. Staley, Md |
|---|---|
| Speciality | Family Medicine |
| Location | 104 N Locust Ave, Lawrenceburg, Tennessee |
| Authorized Official Name and Position | Homer L Staley (PRESIDENT) |
| Authorized Official Contact | 9317626476 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Homer L. Staley, Md 104 N Locust Ave Lawrenceburg TN 38464-3734 Ph: (931) 762-6476 | Homer L. Staley, Md 104 N Locust Ave Lawrenceburg TN 38464-3734 Ph: (931) 762-6476 |
| NPI Number | 1619103579 |
|---|---|
| Provider Enumeration Date | 06/05/2009 |
| Last Update Date | 06/05/2009 |
| Medicare PECOS PAC ID | 2163568734 |
|---|---|
| Medicare Enrollment ID | O20091013000236 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619103579 | NPI | - | NPPES |
| 3170118 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD008952 (Tennessee) | Primary |
| 207QG0300X | Family Medicine - Geriatric Medicine | MD008952 (Tennessee) | Secondary |
| Provider Name | Homer L Staley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609886936 PECOS PAC ID: 2961455258 Enrollment ID: I20050228000078 |
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