Provider Demographics
NPI:1174749469
Name:FRIX-JENNINGS CLINIC PC
Entity type:Organization
Organization Name:FRIX-JENNINGS CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:FRIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-989-0001
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2231
Mailing Address - Country:US
Mailing Address - Phone:731-989-0001
Mailing Address - Fax:731-989-5151
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-2231
Practice Address - Country:US
Practice Address - Phone:731-989-0001
Practice Address - Fax:731-989-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34823207R00000X
TN34836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDA6267OtherRAILROAD MEDICARE
TN3372940Medicaid
TNDA6267OtherRAILROAD MEDICARE