Healthcare Provider Details

I. General information

NPI: 1629408059
Provider Name (Legal Business Name): SPRINGFIELD NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 TENNESSEE ST
BOLIVAR TN
38008-1822
US

IV. Provider business mailing address

PO BOX 190
MIDDLETON TN
38052-0190
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-2411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number40556
License Number StateTN

VIII. Authorized Official

Name: DR. TODD E RUTLAND
Title or Position: OWNER
Credential: M.D.
Phone: 615-384-1740