| Northside Medical Clinic, P.c. | |
|
31 Hughes Dr Jackson TN 38305-1505 | |
| (731) 668-2800 | |
| (731) 668-6161 |
| Full Name | Northside Medical Clinic, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 31 Hughes Dr, Jackson, Tennessee |
| Authorized Official Name and Position | John R. Blenis (ADMINISTRATOR) |
| Authorized Official Contact | 7316682800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northside Medical Clinic, P.c. 31 Hughes Dr Jackson TN 38305-1505 Ph: (731) 668-2800 | Northside Medical Clinic, P.c. 31 Hughes Dr Jackson TN 38305-1505 Ph: (731) 668-2800 |
| NPI Number | 1083781595 |
|---|---|
| Provider Enumeration Date | 11/29/2006 |
| Last Update Date | 12/04/2012 |
| Medicare PECOS PAC ID | 1759283765 |
|---|---|
| Medicare Enrollment ID | O20040121000831 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083781595 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Marion J Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952494643 PECOS PAC ID: 5991731556 Enrollment ID: I20050714000598 |
| Provider Name | Timothy W Hayden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972699494 PECOS PAC ID: 1951337559 Enrollment ID: I20050714000879 |
| Provider Name | Elizabeth S Londino |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922194778 PECOS PAC ID: 6204862808 Enrollment ID: I20050714000889 |
| Provider Name | Hannah M Keymon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952045197 PECOS PAC ID: 6305228438 Enrollment ID: I20220805000161 |
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