Basic Information
| Provider Information | |||||||||
| NPI: | 1962868000 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CVS CAREMARK MINUTE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4805 COLUMBIA PIKE | ||||||||
| Address2: | |||||||||
| City: | THOMPSONS STATION | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371795207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8663892727 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2812 RIPPAVILLA WAY | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371747114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317973329 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2016 | ||||||||
| LastUpdateDate: | 01/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | DUMAINE-PICARD | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 4017709323 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0000020026 | TN | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.