| Medical Direct Care, Plc | |
|
190 Hatcher Lane Suite B Clarksville TN 37040 | |
| (931) 221-0902 | |
| (931) 221-0602 |
| Full Name | Medical Direct Care, Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 190 Hatcher Lane, Clarksville, Tennessee |
| Authorized Official Name and Position | Gregory Marcel Fryer (OWNER) |
| Authorized Official Contact | 9312210902 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Direct Care, Plc 190 Hatcher Lane Suite B Clarksville TN 37040 Ph: (931) 221-0902 | Medical Direct Care, Plc 190 Hatcher Lane Suite B Clarksville TN 37040 Ph: (931) 221-0902 |
| NPI Number | 1104253327 |
|---|---|
| Provider Enumeration Date | 10/02/2013 |
| Last Update Date | 10/02/2013 |
| Medicare PECOS PAC ID | 4981834173 |
|---|---|
| Medicare Enrollment ID | O20140310000982 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104253327 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gregory M Fryer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326013566 PECOS PAC ID: 9739320524 Enrollment ID: I20140310001067 |
| Provider Name | Anna Bushong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790232684 PECOS PAC ID: 5799073557 Enrollment ID: I20220317002799 |
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