1518189000 NPI number — THE METABOLIC GROUP

Table of content: (NPI 1518189000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518189000 NPI number — THE METABOLIC GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE METABOLIC GROUP
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:
Provider Other Organization Name Type Code:
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:
1518189000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 N. ANDERSON LANE
Provider Second Line Business Mailing Address:
#106
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-499-4545
Provider Business Mailing Address Fax Number:
615-499-4546

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N ANDERSON LANE
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-499-4545
Provider Business Practice Location Address Fax Number:
615-499-4546
Provider Enumeration Date:
05/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAUPHIN
Authorized Official First Name:
PASCAL
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-499-4545

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  038238 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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