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300 S Main St # A Estill Springs TN 37330-4042 | |
(615) 612-9397 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 300 S Main St # A, Estill Springs, Tennessee |
Authorized Official Name and Position | Amber Nicole Wooten (OWNER/PROVIDER) |
Authorized Official Contact | 6156129397 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 85 Estill Springs TN 37330-0085 Ph: (615) 612-9397 | 300 S Main St # A Estill Springs TN 37330-4042 Ph: (615) 612-9397 |
NPI Number | 1427829696 |
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Provider Enumeration Date | 01/15/2024 |
Last Update Date | 05/30/2024 |
Medicare PECOS PAC ID | 0446794663 |
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Medicare Enrollment ID | O20240628002248 |
Identifier | Type | State | Issuer |
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1427829696 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Muhamed Faour |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1982672507 PECOS PAC ID: 1850319948 Enrollment ID: I20051107001156 |
Provider Name | Amber N Wooten |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1346010030 PECOS PAC ID: 9234673450 Enrollment ID: I20240628002383 |