Healthcare Provider Details

I. General information

NPI: 1689900474
Provider Name (Legal Business Name): THE MEDICAL MATTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 GANN RD
MILAN TN
38358-6518
US

IV. Provider business mailing address

23 GANN RD
MILAN TN
38358-6518
US

V. Phone/Fax

Practice location:
  • Phone: 731-613-2202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: REBECCA J HAYS
Title or Position: PRINCIPLE MEMBER
Credential:
Phone: 731-613-2202