FAMILY CLINIC AT THE LAKE PLLC (NPI# 1578125647) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578125647 |
| Entity Type | Organization |
| Organization Name | FAMILY CLINIC AT THE LAKE PLLC |
| Practice Address |
11268 Highway 57 Counce TN 38326-3802 |
| Mailing Address |
Po Box 140 Pickwick Dam TN 38365-0140 |
| Practice Telephone | 7316894357 |
| Mailing Telephone | 7316894357 |
| Mailing Fax Number | 7316891050 |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2019-10-14 |
| Authorized Official Name | ELLANIKOLE JACKSON (OWNER) |
| Authorized Official Telephone | 7316894357 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Street Address |
11268 HIGHWAY 57 |
| City | COUNCE |
| State | TN |
| Zip Code | 38326-3802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932676194 | Ellanikole Jackson | Nurse Practitioner | 11268 Highway 57, Counce, TN 38326-3802 | 2018-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013143411 | Eagle Eye Dme LLC | Durable Medical Equipment & Medical Supplies | 11240 Hwy 57, Counce, TN 38326 | 2009-06-01 |
| 1427233410 | Diane Renee Wendt | Social Worker | 240 Rivercliff Lane, Counce, TN 38326 | 2008-01-08 |
| 1366570095 | Jill Ann Blount-clark | Social Worker | 35 Brittney Cv, Counce, TN 38326 | 2007-03-02 |
| 1225058407 | Joseph A Peters | Family Medicine | 8917 Highway 57, Counce, TN 38326 | 2006-07-20 |
| 1437357431 | Joseph Peters, M.d. | Family Medicine | 8917 Highway 57, Counce, TN 38326 | 2007-07-11 |
| 1194033647 | Paula C. Jones | Pharmacist | 9810 Highway 57, Counce, TN 38326-3725 | 2010-09-17 |
| 1548578784 | Beth Hinton | Pharmacist | 9810 Highway 57, Counce, TN 38326-3725 | 2010-09-22 |
| 1083646921 | Freds Stores of Tennessee Inc | Durable Medical Equipment & Medical Supplies | 9810 Highway 57, Counce, TN 38326-3725 | 2006-07-07 |
| 1992032288 | Personal Pharmacy Care LLC | Pharmacy | 11272 Highway 57, Counce, TN 38326-3802 | 2009-11-08 |
| 1104175587 | John Casey Austin | Pharmacist | 11272 Highway 57, Counce, TN 38326-3802 | 2012-08-31 |
| Find all providers in zip 38326 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1588275317 | Henry County Medical Center | Clinic/Center | 300 Hospital Cir Ste 204, Paris, TN 38242-4597 | 2020-08-14 |
| 1447861562 | Henry County Medical Center | Clinic/Center | 14201 Highway 79 N Unit 4, Buchanan, TN 38222-4183 | 2020-08-12 |
| 1003425224 | Dickson Medical Associate, PC | Clinic/Center | 127 Crestview Park Dr Ste 205, Dickson, TN 37055-2856 | 2020-07-23 |
| 1023631454 | Spring City Family Clinic Pllc | Clinic/Center | 126 Lavender St Ste 2, Spring City, TN 37381-5102 | 2020-05-20 |
| 1871001271 | Shelbyville Hospital Company LLC | Clinic/Center | 1330 Cedar Ln Ste 100, Tullahoma, TN 37388-2284 | 2018-01-19 |
| 1720596125 | Shelbyville Hospital Company LLC | Clinic/Center | 1440 Cedar Ln Unit 100, Tullahoma, TN 37388-2262 | 2018-01-19 |
| 1548788458 | Shelbyville Hospital Company LLC | Clinic/Center | 1612 N Main St Ste A, Shelbyville, TN 37160-2392 | 2017-08-31 |
| 1063938520 | Mid-south Convenient Care, Pllc | Clinic/Center | 1445 Us Highway 51 Byp E Ste B, Dyersburg, TN 38024-2127 | 2017-08-16 |
| 1871034462 | Martin Health | Clinic/Center | 143 Kennedy Drive, Martin, TN 38237-3309 | 2017-03-15 |
| 1881135895 | Humboldt Family Walk-in Clinic LLC | Clinic/Center | 1600 Coleman Dr, Humboldt, TN 38343-1756 | 2017-03-10 |
| Find all providers with the same taxonomy | ||||
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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.