| Sale Creek Family Practice, Pllc | |
|
108 Griffith St Sale Creek TN 37373-9715 | |
| (423) 332-1813 | |
| (423) 332-7732 |
| Full Name | Sale Creek Family Practice, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 108 Griffith St, Sale Creek, Tennessee |
| Authorized Official Name and Position | Daniel T. Black (OWNER) |
| Authorized Official Contact | 4233321813 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sale Creek Family Practice, Pllc Po Box 746 Chattanooga TN 37401-0746 Ph: (423) 877-2312 | Sale Creek Family Practice, Pllc 108 Griffith St Sale Creek TN 37373-9715 Ph: (423) 332-1813 |
| NPI Number | 1225352164 |
|---|---|
| Provider Enumeration Date | 03/22/2010 |
| Last Update Date | 03/22/2010 |
| Medicare PECOS PAC ID | 3274663737 |
|---|---|
| Medicare Enrollment ID | O20100609000572 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225352164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 1671 (Tennessee) | Primary |
| Provider Name | Daniel Timothy Black |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194726604 PECOS PAC ID: 4183675556 Enrollment ID: I20050718000038 |
Daniel T Black Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 108 Griffith St, Sale Creek, TN 37373 Phone: 423-332-1813 Fax: 423-332-7732 | |
Sale Creek Primary Care, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 14402 Dayton Pike Ste C, Sale Creek, TN 37373 Phone: 423-498-3560 Fax: 423-498-3563 |