MEDICARE: BTDI JV, LLP

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1659763316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BTDI JV, LLP

Provider Business Mailing Address
First Line	:	1431 PERRONE WAY
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37069-4243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	614 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1637
Country	:	US
Telephone Number	:	615-661-9200
Fax Number	:	615-661-9297

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CLETE MADDEN
Credential	:
Telephone Number	:	615-661-9200

Provider Enumeration Date	:	03/04/2015
Last Update Date	:	11/14/2016

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