Healthcare Provider Details

I. General information

NPI: 1417239757
Provider Name (Legal Business Name): NEXSLIM OF HERMITAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD SUITE 207
HERMITAGE TN
37076-2054
US

IV. Provider business mailing address

5123 VIRGINIA WAY A-23
BRENTWOOD TN
37027-7519
US

V. Phone/Fax

Practice location:
  • Phone: 615-678-6357
  • Fax:
Mailing address:
  • Phone: 615-732-0768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number StateTN

VIII. Authorized Official

Name: MR. C SCOTT MOYER
Title or Position: CEO
Credential:
Phone: 615-732-0768