1. Home
  2. Directory
  3. Tennessee
  4. Tullahoma
  5. Specialist
  6. NPI Profile

MARVEL CLINIC P.C.
NPI 1760487086
Specialist in Tullahoma, TN

Active since June 14, 2005
1821 N WASHINGTON ST, TULLAHOMA, TN 37388(931) 455-2005(931) 455-4450 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Marvel Clinic P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARVEL CLINIC P.C. (NPI 1760487086) is a healthcare organization registered as a specialist in Tullahoma, Tennessee and active in the NPI registry since June 2005. The organization lists Tracy Dawn Wilkins, Credentialing Facilitator, as its authorized official.

NPPES Registry Identity

NPI1760487086
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameMARVEL CLINIC P.C.
Location Address1821 N WASHINGTON STTullahoma, TN 37388-2221
Mailing Address1821 N Washington StTullahoma, TN 37388-2221 · (931) 455-2005 · Fax (931) 455-4450
Phone(931) 455-2005
Fax(931) 455-4450
Organization SubpartNo
Authorized OfficialTracy Dawn WilkinsCredentialing Facilitator · (931) 461-5056
Enumeration DateJune 14, 2005
Last NPPES UpdateAugust 22, 2020
✔ NPI 1760487086 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1821 N WASHINGTON ST, Tullahoma, TN 37388
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Marvel Clinic P.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Marvel Clinic P.C., which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Jordan Licata, DO
Otolaryngology
NPI 1952795106
1821 N WASHINGTON ST
Tullahoma, TN 37388
(931) 461-5056
✔ PECOS✔ Accepts MedicareSame address
Jeffrey Marvel, M.D.
Otolaryngology
NPI 1740285063
1821 N WASHINGTON ST
Tullahoma, TN 37388
(931) 455-2005
✔ PECOS✔ Accepts MedicareSame address
Ladonna Ledford, NP
Nurse Practitioner
NPI 1073671756
215 S ANDERSON ST
Tullahoma, TN 37388
(931) 563-7464
✔ PECOS✔ Accepts Medicare1.8 mi
Michael Cruz, CRNA
Certified Registered Nurse Anesthetist (CRNA)
NPI 1740364033
1559 SPARTA RD RIVER PARK HOSPITAL
Mcminnville, TN 37110
(423) 855-0700
✔ Accepts Medicare35 mi
Jonathan Bennett
Certified Registered Nurse Anesthetist (CRNA)
NPI 1659504645
2341 MCCALLIE AVE SUITE 402
Chattanooga, TN 37404
(423) 698-3309
✔ Accepts Medicare59 mi
Laurie Butler, CRNA
Certified Registered Nurse Anesthetist (CRNA)
NPI 1356617567
110 29TH AVE N STE 202
Nashville, TN 37203
(615) 327-4304
✔ PECOS✔ Accepts Medicare62 mi
Theresa Bonner, CRNA
Certified Registered Nurse Anesthetist (CRNA)
NPI 1144298761
324 22ND AVE N
Nashville, TN 37203
(615) 329-4401
✔ Accepts Medicare62 mi
Jennifer Chambers, CRNA
Certified Registered Nurse Anesthetist (CRNA)
NPI 1588644819
755 N 11TH ST SUITE P3600
Beaumont, TX 77702
(409) 838-5214
✔ Accepts Medicare587 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Marvel Clinic P.C.'s NPI number?

The NPI number for Marvel Clinic P.C. is 1760487086. It was assigned to this organization in the NPPES registry on June 14, 2005.

Where is Marvel Clinic P.C. located?

Marvel Clinic P.C. is located at 1821 N Washington St, Tullahoma, TN 37388. The listed phone number is (931) 455-2005.

What is Marvel Clinic P.C.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Marvel Clinic P.C. enrolled in Medicare?

Yes. Marvel Clinic P.C. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Marvel Clinic P.C.?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 3 Medicare specialties reassign their Medicare billing to Marvel Clinic P.C.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Certified Registered Nurse Anesthetist (CRNA) (5), Otolaryngology (2) and Nurse Practitioner (1). Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Marvel Clinic P.C. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.