Organization Name: | PETTY ADULT AND GERIATRIC CARE CLINIC LLC |
NPI Number: | 1457530560 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIFER ANN PETTY (ORGANIZER) |
Mailing Address: | 1123 N Castle Heights Ave Suite H Lebanon |
State: | TN US |
Postal Code: | 370875724 |
Phone Number: | 6154432273 |
Fax Number: | 6154493111 |
NPI Enumeration Date: | 10/25/2007 |
NPI Last Update Date: | 10/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261Q00000X |
License Number: | 11466 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |