Provider Demographics
NPI:1487364709
Name:ACUTE CARE CLINIC CLARKRANGE
Entity type:Organization
Organization Name:ACUTE CARE CLINIC CLARKRANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:EROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-200-2246
Mailing Address - Street 1:100 S DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-3009
Mailing Address - Country:US
Mailing Address - Phone:931-863-5095
Mailing Address - Fax:931-863-3530
Practice Address - Street 1:6845 S YORK HWY
Practice Address - Street 2:
Practice Address - City:CLARKRANGE
Practice Address - State:TN
Practice Address - Zip Code:38553-5102
Practice Address - Country:US
Practice Address - Phone:931-863-5095
Practice Address - Fax:931-863-3530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACUTE CARE CLINICS OF AMERICA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty