| West Tennessee Medical Group Hillview South Clinic | |
|
1135 Broadway Street South Fulton TN 38257-2835 | |
| (731) 479-2606 | |
| (731) 479-2610 |
| Full Name | West Tennessee Medical Group Hillview South Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1135 Broadway Street, South Fulton, Tennessee |
| Authorized Official Name and Position | James Ross (PRESIDENT AND CEO) |
| Authorized Official Contact | 7315416731 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Tennessee Medical Group Hillview South Clinic 1135 Broadway Street South Fulton TN 38257-2835 Ph: (731) 479-2606 | West Tennessee Medical Group Hillview South Clinic 1135 Broadway Street South Fulton TN 38257-2835 Ph: (731) 479-2606 |
| NPI Number | 1669876520 |
|---|---|
| Provider Enumeration Date | 10/21/2014 |
| Last Update Date | 08/29/2018 |
| Medicare PECOS PAC ID | 5193070613 |
|---|---|
| Medicare Enrollment ID | O20180725000082 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669876520 | NPI | - | NPPES |
| 044-3449 | Medicaid | TN | |
| Q012738 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 0000000126 (Tennessee) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Hillview South Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1135 Broadway St, South Fulton, TN 38257 Phone: 731-479-2606 Fax: 731-479-2610 |