| Makarios Group 3 Llc | |
|
9160 Us Highway 64 Ste 105 Lakeland TN 38002-3011 | |
| (901) 213-0100 | |
| (901) 213-0101 |
| Full Name | Makarios Group 3 Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9160 Us Highway 64 Ste 105, Lakeland, Tennessee |
| Authorized Official Name and Position | Timothy Long (MANAGER) |
| Authorized Official Contact | 9012130100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Makarios Group 3 Llc 9160 Us Highway 64 Ste 105 Lakeland TN 38002-3011 Ph: (901) 213-0100 | Makarios Group 3 Llc 9160 Us Highway 64 Ste 105 Lakeland TN 38002-3011 Ph: (901) 213-0100 |
| NPI Number | 1023427853 |
|---|---|
| Provider Enumeration Date | 08/06/2014 |
| Last Update Date | 06/27/2022 |
| Medicare PECOS PAC ID | 7517277171 |
|---|---|
| Medicare Enrollment ID | O20151111000092 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023427853 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lissa N Roux |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902151095 PECOS PAC ID: 8729235262 Enrollment ID: I20120905000776 |
| Provider Name | Jennifer R Dunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336580190 PECOS PAC ID: 6608007018 Enrollment ID: I20140328000629 |
| Provider Name | Nicole L Charles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083190359 PECOS PAC ID: 4385045434 Enrollment ID: I20210625002214 |
Makarios Group 5, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8950 Us Highway 64, Suite 109, Lakeland, TN 38002 Phone: 901-213-0100 Fax: 901-213-0101 | |
Mid South Med, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 9160 Highway 64, Suite 5, Lakeland, TN 38002 Phone: 901-623-3587 Fax: 901-213-9235 |