Healthcare Provider Details

I. General information

NPI: 1588996656
Provider Name (Legal Business Name): MIDDLE TENNESSEE PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 HIGHWAY 49 E
PLEASANT VIEW TN
37146-7159
US

IV. Provider business mailing address

2536 HIGHWAY 49 E
PLEASANT VIEW TN
37146-7159
US

V. Phone/Fax

Practice location:
  • Phone: 615-746-1557
  • Fax: 615-746-1615
Mailing address:
  • Phone: 615-746-1557
  • Fax: 615-746-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRED NORDQUIST
Title or Position: PRESIDENT
Credential: MD
Phone: 615-337-3843