Basic Information
| Provider Information | |||||||||
| NPI: | 1508871302 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARTHAGE FAMILY PRACTICE SPECIALISTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 176 | ||||||||
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| City: | CARTHAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370300176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157350700 | ||||||||
| FaxNumber: | 6157355480 | ||||||||
| Practice Location | |||||||||
| Address1: | 133 HOSPITAL DR | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | CARTHAGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370304004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157350700 | ||||||||
| FaxNumber: | 6157355480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 04/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | WEST | ||||||||
| AuthorizedOfficialFirstName: | COURTNEY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6157355401 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3389733 | 05 | TN | MEDICAID |