Healthcare Provider Details

I. General information

NPI: 1598021784
Provider Name (Legal Business Name): MID- TN THERAPEUTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2246 KEENLAND COMMERCIAL BLVD
MURFREESBORO TN
37127-3909
US

IV. Provider business mailing address

2246 KEENLAND COMMERCIAL BLVD
MURFREESBORO TN
37127-3909
US

V. Phone/Fax

Practice location:
  • Phone: 615-907-9771
  • Fax: 615-907-9545
Mailing address:
  • Phone: 615-907-9771
  • Fax: 615-907-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD013323
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000006108
License Number StateTN

VIII. Authorized Official

Name: RICHARD EUGENE FISHBEIN
Title or Position: OWNER/ MEDICAL DIRECTOR
Credential: MD
Phone: 615-907-9771