Healthcare Provider Details

I. General information

NPI: 1891292074
Provider Name (Legal Business Name): BTDI JV, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 BROAD PARK CIR S STE 300
MANSFIELD TX
76063-7835
US

IV. Provider business mailing address

1431 PERRONE WAY
FRANKLIN TN
37069-4244
US

V. Phone/Fax

Practice location:
  • Phone: 615-661-9200
  • Fax:
Mailing address:
  • Phone: 615-620-5542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: BRIAN J SMITH
Title or Position: CHIEF DEVELOPMENT OFFICER & TREASUR
Credential:
Phone: 615-620-9200