Provider Demographics
NPI:1932084274
Name:MCKENZIE MEDICAL CENTER PC
Entity type:Organization
Organization Name:MCKENZIE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ETHERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-678-0055
Mailing Address - Street 1:1731 S MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:38230
Mailing Address - Country:US
Mailing Address - Phone:731-678-0055
Mailing Address - Fax:731-678-0059
Practice Address - Street 1:1731 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:TN
Practice Address - Zip Code:38230
Practice Address - Country:US
Practice Address - Phone:731-678-0055
Practice Address - Fax:731-678-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health