1750387635 NPI number — TENNESSEE ADVANCED NEURODIAGNOSTIC INSTITUTE, INC. (TANII)

Table of content: (NPI 1750387635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750387635 NPI number — TENNESSEE ADVANCED NEURODIAGNOSTIC INSTITUTE, INC. (TANII)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENNESSEE ADVANCED NEURODIAGNOSTIC INSTITUTE, INC. (TANII)
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
3T NEUROIMAGING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750387635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601449
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75360-1449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-368-9966
Provider Business Mailing Address Fax Number:
214-368-9977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4525 HARDING RD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-463-3034
Provider Business Practice Location Address Fax Number:
615-463-3187
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DRIBER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/ CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
615-463-3034

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7980634 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3791325 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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