| The Kennedy Clinic PLLC | |
|
4957 Swinyar Dr Ste 109 Ooltewah TN 37363-2205 | |
| (423) 396-9893 | |
| (423) 396-9508 |
| Full Name | The Kennedy Clinic PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 4957 Swinyar Dr Ste 109, Ooltewah, Tennessee |
| Authorized Official Name and Position | Howard Michael Kennedy (MANAGING MEMBER) |
| Authorized Official Contact | 4234323130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Kennedy Clinic PLLC 4957 Swinyar Dr Suite 109 Ooltewah TN 37363 Ph: (423) 432-3130 | The Kennedy Clinic PLLC 4957 Swinyar Dr Ste 109 Ooltewah TN 37363-2205 Ph: (423) 396-9893 |
| NPI Number | 1508078445 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 09/12/2024 |
| Certification Date | 09/12/2024 |
| Medicare PECOS PAC ID | 2769574219 |
|---|---|
| Medicare Enrollment ID | O20070828000948 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508078445 | NPI | - | NPPES |
| 1942280052 | Other | TN | KENNEDY NPI# |
| 413276426 | Other | TN | KENNEDY SS# |
| 4136940 | Other | TN | KENNEDY BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Howard M Kennedy |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1942280052 PECOS PAC ID: 4385682400 Enrollment ID: I20050420000181 |
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