1407193543 NPI number — CENTER FOR SPINE JOINT & NEUROMUSCULAR REHAB PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407193543 NPI number — CENTER FOR SPINE JOINT & NEUROMUSCULAR REHAB PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR SPINE JOINT & NEUROMUSCULAR REHAB PC
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:
1407193543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5651 FRIST BLVD
Provider Second Line Business Mailing Address:
SUITE 712
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37076-2054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-872-9966
Provider Business Mailing Address Fax Number:
615-564-9308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
541 N MOUNT JULIET RD
Provider Second Line Business Practice Location Address:
SUITE 2103
Provider Business Practice Location Address City Name:
MOUNT JULIET
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37122-3873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-872-9966
Provider Business Practice Location Address Fax Number:
615-564-9308
Provider Enumeration Date:
01/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
SON
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
615-872-9966

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com