BROADWAY FAMILY PRACTICE (NPI# 1578092938) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578092938 |
| Entity Type | Organization |
| Organization Name | BROADWAY FAMILY PRACTICE |
| Practice Address |
1179 Highway 11w Bean Station TN 37708 |
| Mailing Address |
1179 Highway 11w Bean Station TN 37708-5809 |
| Practice Telephone | (865) 993-1070 |
| Practice Fax Number | 8659931075 |
| Mailing Telephone | 8659931070 |
| Mailing Fax Number | 8659931075 |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2017-06-08 |
| Authorized Official Name | MR. SHANNON SHULTZ (OWNER) |
| Authorized Official Telephone | 8659931070 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | BROADWAY FAMILY PRACTICE LLC | 7391 S Costilla St, Littleton, CO 80120-3928 |
| Street Address |
1179 HIGHWAY 11W |
| City | BEAN STATION |
| State | TN |
| Zip Code | 37708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255594487 | Bean Station Family Medicine, PC | Clinic/Center | 1179 Highway 11w, Bean Station, TN 37708-5809 | 2008-07-08 |
| 1265771281 | Southern Care Clinic LLC | Clinic/Center | 1179 Highway 11w, Bean Station, TN 37708-5809 | 2013-02-11 |
| 1699931857 | Latasha M Seal | Nurse Practitioner | 1179 Highway 11w, Bean Station, TN 37708-5809 | 2008-08-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346572591 | Miranda Russell | Counselor | 105 Rowdy Row, Bean Station, TN 37708 | 2010-02-12 |
| 1992908719 | Stephen Paul Mayo | Dentist | 1277 Hwy 11w, Suite F, Bean Station, TN 37708 | 2007-06-08 |
| 1629108279 | Neil E Mccoy | Chiropractor | 614 Broadway Drive, Bean Station, TN 37708 | 2007-03-06 |
| 1780682906 | Amanullah Siddiqi | Emergency Medicine | 1285 Highway 11w, Bean Station, TN 37708 | 2005-07-12 |
| 1073646022 | Christina Michelle Merritt | Case Manager/Care Coordinator | 1285 Highway 11w, Bean Station, TN 37708 | 2007-03-13 |
| 1366552689 | William L Martin II | Family Medicine | 1030 Main St, Bean Station, TN 37708 | 2006-08-30 |
| 1184123382 | Ashley Mckinney | Registered Nurse | 290 Springwood Dr, Bean Station, TN 37708-3003 | 2018-02-03 |
| 1568012201 | Nathan Ray Martin | Pharmacist | 1034 Main St, Bean Station, TN 37708-4257 | 2019-09-15 |
| 1013467166 | Morgan Kay Black | Physical Therapist | 1030 Main St, Bean Station, TN 37708-4257 | 2016-10-12 |
| 1356794812 | Amy Hall | Pharmacy Technician | 1034 Main St, Bean Station, TN 37708-4257 | 2016-07-20 |
| Find all providers in zip 37708 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255594487 | Bean Station Family Medicine, PC | Clinic/Center | 1179 Highway 11w, Bean Station, TN 37708-5809 | 2008-07-08 |
| 1265771281 | Southern Care Clinic LLC | Clinic/Center | 1179 Highway 11w, Bean Station, TN 37708-5809 | 2013-02-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780281527 | Braxton Medical Clinic, LLC | Clinic/Center | 1410 Kensington Square Ct Ste 103, Murfreesboro, TN 37130-6902 | 2020-10-05 |
| 1629689674 | Saint Thomas Medical Partners | Clinic/Center | 220 West Jefferson Pike, Murfreesboro, TN 37129 | 2020-08-13 |
| 1700411592 | Fentress Family Care LLC | Clinic/Center | 1010 Old Highway 127 S, Jamestown, TN 38556-5648 | 2020-03-11 |
| 1831724822 | Guiding Star Memphis | Clinic/Center | 2980 Poplar Ave Ste 101, Memphis, TN 38111-3527 | 2020-03-10 |
| 1407486764 | Elijahs Dream Compassionate Care | Clinic/Center | 134 Creekside Dr Ste 1, Ocoee, TN 37361-3653 | 2020-01-24 |
| 1518506542 | Faith Medical Group, Pllc | Clinic/Center | 500 Mcfarland St Ste E, Morristown, TN 37814-3992 | 2019-12-20 |
| 1366080582 | Matthew E. Schantz, M.d. | Clinic/Center | 206 S Military St Ste 1, Loretto, TN 38469-2101 | 2019-12-18 |
| 1114563749 | Step One Medical Associates PC | Clinic/Center | 4502 Bristol Hwy, Johnson City, TN 37601-2936 | 2019-11-19 |
| 1023665403 | Elite Healthcare, LLC | Clinic/Center | 117 N 3rd St, Kingston, TN 37763-2842 | 2019-08-21 |
| 1083266381 | Get Into Shape Md | Clinic/Center | 5803 Lee Hwy Ste 101, Chattanooga, TN 37421-3547 | 2019-07-16 |
| Find all providers with the same taxonomy | ||||
| City | BEAN STATION |
| Zip Code | 37708 |
Please comment or provide details below to improve the information on BROADWAY FAMILY PRACTICE.
| 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.