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NPI Code Detail

MEDICARE: MIDDLE TENNESSEE ADDICTION CLINIC

MEDICARE: MIDDLE TENNESSEE ADDICTION CLINIC
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center10243TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24307400OTHERTNBLUE CROSS

General Provider Information

NPI Number : 1427417450
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDDLE TENNESSEE ADDICTION CLINIC
Provider Business Mailing Address
First Line : 801 HILL ST
Second Line :
City : SPRINGFIELD
State : TN
Zip : 37172-2951
Country : US
Telephone Number : 615-382-3002
Fax Number : 615-382-2295
Provider Business Practice Location Address
First Line : 801 HILL ST
Second Line :
City : SPRINGFIELD
State : TN
Zip : 37172-2951
Country : US
Telephone Number : 615-382-3002
Fax Number : 615-382-2295
Authorized Official
Title or Position : OWNER
Name : DR. ROBERT ALLEN SHEARER
Credential : MD
Telephone Number : 615-382-3002
Provider Enumeration Date : 02/18/2016
Last Update Date : 02/18/2016

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Directions to “MIDDLE TENNESSEE ADDICTION CLINIC ” Practice Location

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