Provider Demographics
NPI:1023146099
Name:COLUMBIA PEDIATRIC CLINIC, INC.
Entity type:Organization
Organization Name:COLUMBIA PEDIATRIC CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:931-388-8965
Mailing Address - Street 1:1222 TROTWOOD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6436
Mailing Address - Country:US
Mailing Address - Phone:931-388-8965
Mailing Address - Fax:931-388-0815
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:STE 101
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6436
Practice Address - Country:US
Practice Address - Phone:931-388-8965
Practice Address - Fax:931-388-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care