The Kennedy Clinic PLLC
Clinic/Center, Primary Care in Ooltewah, TN. Organization (NPI-2).
NPI number1508078445
StatusActive
Last updated in NPPESSep 12, 2024
Details
- NPI
- 1508078445
- Entity type
- Organization (NPI-2)
- Legal business name
- The Kennedy Clinic PLLC
- Organization subpart
- No
- Enumeration date
- May 4, 2007
- Certification date
- Sep 12, 2024
- Last updated
- Sep 12, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
Practice location
4957 Swinyar Dr Ste 109Ooltewah, TN 37363-2205
Phone 423-396-9893 · Fax 423-396-9508
Mailing address
4957 Swinyar DrSuite 109
Ooltewah, TN 37363
Phone 423-432-3130 · Fax 423-396-9508
Authorized official
Howard Michael Kennedy
Managing Member
4234323130
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