1235328485 NPI number — MIDDLE TENNESSEE LOCUM SERVICES INC

Table of content: (NPI 1235328485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235328485 NPI number — MIDDLE TENNESSEE LOCUM SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLE TENNESSEE LOCUM SERVICES INC
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:
1235328485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 116331
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-6331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-287-5718
Provider Business Mailing Address Fax Number:
813-287-5728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5404 HOOVER BLVD
Provider Second Line Business Practice Location Address:
STE 20
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33634-5333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-287-5718
Provider Business Practice Location Address Fax Number:
813-287-5728
Provider Enumeration Date:
10/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
615-702-7060

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com