| Lebanon General Practice Inc | |
|
228 W Main St Ste B Lebanon TN 37087-2681 | |
| (615) 784-4621 | |
| (615) 784-4623 |
| Full Name | Lebanon General Practice Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 228 W Main St Ste B, Lebanon, Tennessee |
| Authorized Official Name and Position | Dawn Johnson (MEDICAL BILLING) |
| Authorized Official Contact | 6157844621 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lebanon General Practice Inc 228 W Main St Ste B Lebanon TN 37087-2681 Ph: (615) 784-4621 | Lebanon General Practice Inc 228 W Main St Ste B Lebanon TN 37087-2681 Ph: (615) 784-4621 |
| NPI Number | 1659496040 |
|---|---|
| Provider Enumeration Date | 03/21/2007 |
| Last Update Date | 03/18/2020 |
| Certification Date | 03/18/2020 |
| Medicare PECOS PAC ID | 1153331418 |
|---|---|
| Medicare Enrollment ID | O20090225000701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659496040 | NPI | - | NPPES |
| 3832478 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Thomas a Kowal |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1043205008 PECOS PAC ID: 1850301110 Enrollment ID: I20060508000353 |
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