1629078670 NPI number — MIDDLE TENNESSEE FAMILY MEDICINE

Table of content: (NPI 1629078670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629078670 NPI number — MIDDLE TENNESSEE FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDDLE TENNESSEE FAMILY MEDICINE
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:
6
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:
1629078670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 440163
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37244-0163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-848-2900
Provider Business Mailing Address Fax Number:
615-848-2956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
237 W NORTHFIELD BLVD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37129-0531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-848-2900
Provider Business Practice Location Address Fax Number:
615-848-2956
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LANGWORTHY
Authorized Official First Name:
WARREN
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-848-2900

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , 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)





Copyright © 2007-2025 www.npivalidator.com