Healthcare Provider Details

I. General information

NPI: 1013519230
Provider Name (Legal Business Name): NES TENNESSEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 05/16/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 S ALABAMA AVE
MONROEVILLE AL
36460-3044
US

IV. Provider business mailing address

PO BOX 31105
BELFAST ME
04915-0140
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-3111
  • Fax:
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-697-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ANN MOORE
Title or Position: CEO
Credential:
Phone: 415-435-4591