PROVIDENCE FAMILY MEDICINE (NPI# 1437703741) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437703741 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE FAMILY MEDICINE |
| Practice Address |
287 W Turn Table Rd Sparta TN 38583-1366 |
| Practice Telephone | 9318363262 |
| Practice Fax Number | 9318363269 |
| Mailing Telephone | 9318363262 |
| Mailing Fax Number | 9318363269 |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2020-11-03 |
| Authorized Official Name | MRS. KATINA E HUFF (OWNER) |
| Authorized Official Telephone | 9318363262 |
| Authorized Official Credential | PAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 1529553 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Ohio Business Entities | PROVIDENCE FAMILY MEDICINE - WAYNESVILLE | 2912 Springboro West, Suite 201, Dayton, OH 45439 |
| Virginia Business Entities | Providence Family Medicine P.C. | 8303 Arlington Blvd Ste 109, Fairfax, Virginia 22031 |
| Street Address |
287 W TURN TABLE RD |
| City | SPARTA |
| State | TN |
| Zip Code | 38583-1366 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538769047 | Results-ast Jv, LLC | Physical Therapist | 421 Sewell Road, Sparta, TN 38583 | 2020-10-26 |
| 1588282917 | Rock House Medical Supply, LLC | Durable Medical Equipment & Medical Supplies | 25 N Spring St, Sparta, TN 38583 | 2020-07-13 |
| 1881215333 | Nancy Marie Rutherford | Physical Therapist | 421 Sewell Drive, Sparta, TN 38583 | 2020-05-06 |
| 1942798210 | Oscar Dale Sims | Pharmacist | 202 Sam Walton Drive, Sparta, TN 38583 | 2018-04-23 |
| 1932622644 | Medicherla Shyam Sunder Kumar | Internal Medicine | 401 Sewell Road, Sparta, TN 38583 | 2017-07-25 |
| 1972852341 | Jtp Enterprises, LLC | Clinic/Center | 287 Turntable Rd., Sparta, TN 38583 | 2012-08-31 |
| 1154619898 | Abbie Howell | Pharmacist | 460 West Bockman Way, Sparta, TN 38583 | 2011-07-15 |
| 1164556759 | Leslie Ann Reagan | Pharmacist | 207 West Town Plaza, Sparta, TN 38583 | 2007-03-15 |
| 1497809875 | Waymon Haston | Dentist | 9-a Hampton Drive, Sparta, TN 38583 | 2007-01-22 |
| 1407920127 | Jeffry Alan Belknap | Internal Medicine | 809 W Bockman Way, Sparta, TN 38583 | 2006-11-17 |
| Find all providers in zip 38583 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700302171 | Blake Huddleston | Physician Assistant | 150 Sam Walton Dr Ste 300, Sparta, TN 38583-8813 | 2017-08-17 |
| 1649707373 | Cierra Nichole Walters | Physician Assistant | 464 Ghettis St, Sparta, GA 31087-2307 | 2017-05-12 |
| 1396797924 | Gary Detweiler | Physician Assistant | 475 S State St, Sparta, MI 49345-1549 | 2006-05-16 |
| 1992762116 | Dana Lakatos | Physician Assistant | 1300 N Market St, Sparta, IL 62286-1048 | 2006-05-01 |
| 1316583412 | Kayvon Ameri | Physician Assistant | 376 Lafayette Rd Ste 202, Sparta, NJ 07871-3560 | 2019-11-23 |
| 1497213078 | Lindsey A Crawford | Physician Assistant | 2111 12 Mile Rd Nw, Sparta, MI 49345-9754 | 2019-03-04 |
| 1447611082 | Julie Anne Vandermale | Physician Assistant | 475 S State St, Sparta, MI 49345-1549 | 2016-03-10 |
| 1154794865 | Botanical Emergency Physicians, LLC | Physician Assistant | 401 Sewell Dr, Sparta, TN 38583-1223 | 2015-11-03 |
| 1861896250 | Jenna Salvati | Physician Assistant | 2111 12 Mile Rd Nw, Sparta, MI 49345-9754 | 2014-10-15 |
| 1255730479 | Danielle Renee Preuss | Physician Assistant | 1300 N Market St, Sparta, IL 62286-1048 | 2014-08-14 |
| Find all providers in SPARTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.