Provider Demographics
NPI:1801886999
Name:VOLUNTEER MEDICAL GROUP, P.C.
Entity type:Organization
Organization Name:VOLUNTEER MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SULLIVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-783-2334
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38503-0938
Mailing Address - Country:US
Mailing Address - Phone:931-783-2334
Mailing Address - Fax:931-783-2253
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4294
Practice Address - Country:US
Practice Address - Phone:931-783-2334
Practice Address - Fax:931-783-2253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VOLUNTEER MEDICAL GROUP, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-28
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X
TN207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN165594900OtherGROUP'S DOL PROV#
TN165594900OtherGROUP'S DOL PROV#