WADE FAMILY MEDICINE, LLC. (NPI# 1629586375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629586375 |
| Entity Type | Organization |
| Organization Name | WADE FAMILY MEDICINE, LLC. |
| Practice Address |
115 S Munford St Covington TN 38019-2527 |
| Practice Telephone | 9012444646 |
| Practice Fax Number | 9012444646 |
| Mailing Telephone | 9012444646 |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2019-06-11 |
| Authorized Official Name | MODEANNA LEIGH WADE (OWNER) |
| Authorized Official Telephone | 9012444646 |
| Authorized Official Credential | ANP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities | ||
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
16204 | TN | Ambulatory Health Care Facilities |
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
16204 | TN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 1525986 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 360 Watkins Rd, Drummonds, TN 380232920 | 9012460027 | |
| 4501 Mueller Brass Rd, Covington, TN 380193749 | 9012444646 |
| Street Address |
115 S MUNFORD ST |
| City | COVINGTON |
| State | TN |
| Zip Code | 38019-2527 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265505838 | B. E. Massengill | Dentist | 115 S Munford St, Covington, TN 38019-2527 | 2006-11-15 |
| 1700292794 | Bob Dalsania Dds PC | Dentist | 115 S Munford St, Covington, TN 38019-2527 | 2014-07-10 |
| 1760767016 | Modeanna Leigh Wade | Nurse Practitioner | 115 S Munford St, Covington, TN 38019 | 2011-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255957361 | Pcs Midsouth Transport LLC | Non-emergency Medical Transport (VAN) | 1723 Highway 51 S Ste E, Covington, TN 38019 | 2020-06-24 |
| 1972157410 | Deondra Edwards | Nurse Practitioner | 1618 Highway 51, Suites A&b, Covington, TN 38019 | 2019-08-01 |
| 1609395938 | Lauren Hill | Physician Assistant | 1618 Us 51, Covington, TN 38019 | 2017-09-19 |
| 1871991398 | Paul W. Hutchison, D.p.m. | Podiatrist | 105-d Mueller Brass Road, Covington, TN 38019 | 2014-12-16 |
| 1245586874 | Anne Marie Griffin | Nurse Practitioner | 1997 Highway 51 South, Professional Care Services of West Tennessee, Covington, TN 38019 | 2012-08-01 |
| 1720353782 | Katie Ann Daggett | Physician Assistant | 1618 Us 51 South, Suite A, Covington, TN 38019 | 2012-03-09 |
| 1245491547 | Amber Richa Hobbs-buchner | Dentist | 720 W. Sherrod Ave, Covington, TN 38019 | 2008-06-19 |
| 1598970758 | Roger Ganier Jr. | Dentist | 635 Hwy 51 S., Covington, TN 38019 | 2007-05-11 |
| 1679607923 | West Tennessee Eye | Optometrist | 1999 Hwy 51 South, Suite B, Covington, TN 38019 | 2007-03-16 |
| 1518017771 | State of Tennessee | Public Health or Welfare | 4700 Mueller Brass Road, Covington, TN 38019 | 2007-01-11 |
| Find all providers in zip 38019 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
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| 1942754361 | Careatc - Charms | Clinic/Center | 899 Hope St, Covington, TN 38019-1805 | 2016-08-15 |
| 1073066056 | Wellness for Life | Clinic/Center | 1325 2nd St Ste B, Covington, IN 47932-1009 | 2016-07-26 |
| 1245432350 | Covington Health Clinic Incorporated | Clinic/Center | 402 North Fifth Street, Covington, OK 73730-0093 | 2007-06-01 |
| 1639720030 | Careatc | Clinic/Center | 899 Hope St, Covington, TN 38019-1805 | 2019-09-26 |
| 1932641669 | The Family Practice At Northshore Counseling and Wellness, LLC | Clinic/Center | 201 Holiday Blvd, Suite 120, Covington, LA 70433-5088 | 2016-11-11 |
| 1093150468 | Covington Pediatrics, Pllc | Clinic/Center | 411 W Riverside St, Covington, VA 24426-1273 | 2013-04-30 |
| 1538400031 | Covington Chiropractic LLC | Clinic/Center | 26708 180th Ave Se, Suite102, Covington, WA 98042-4969 | 2013-03-07 |
| 1073693958 | Northlake Medicine and Wellness Center, LLC | Clinic/Center | 1980 N Highway 190, Covington, LA 70433-5158 | 2006-10-16 |
| 1154330348 | Eastside Medspa and Family Practice Inc. | Clinic/Center | 7138 Highway 212, Suite D, Covington, GA 30016-8047 | 2006-08-05 |
| Find all providers in COVINGTON | ||||
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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.