MEDICARE: MIDDLE TENNESSEE LOCUM SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1235328485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE TENNESSEE LOCUM SERVICES INC

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

Provider Business Practice Location Address
First Line	:	5404 HOOVER BLVD
Second Line	:	STE 20
City	:	TAMPA
State	:	FL
Zip	:	33634-5333
Country	:	US
Telephone Number	:	813-287-5718
Fax Number	:	813-287-5728

Authorized Official
Title or Position	:	MANAGER
Name	:	JOHN MOORE
Credential	:	CRNA
Telephone Number	:	615-702-7060

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	11/09/2007

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