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General NPI Number Information
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NPI Number | 1437299195
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Entity Type | Organization
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Legal Business Name | STONES RIVER MEDICAL GROUP PC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 726 S. CHURCH STREET
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City | MURFREESBORO
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State | TN
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Zip | 37130
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Country | US
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Telephone | 615-893-7786
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Fax | 615-893-7215
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Provider Business Mailing Address
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Address Line | 726 S CHURCH ST
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City | MURFREESBORO
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State | TN
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Zip | 37130-4926
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Country | US
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Telephone | 615-893-7786
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Fax | 615-893-4811
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MARK S. JOSOVITZ
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Credential | M.D.
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Telephone | 615-893-7786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD7304
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2278E1000X
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Taxonomy Name | Educational Certified Respiratory Therapist
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License Number | CRT000000948
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2279E1000X
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Taxonomy Name | Educational Registered Respiratory Therapist
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License Number | RRT0000003934
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 18433
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License Number State | TN
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