=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558880286
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHCARE RESOURCES MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2017
-----------------------------------------------------
Last Update Date | 09/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74 LEBANON HWY
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37030-2954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-735-8002
-----------------------------------------------------
Fax | 615-735-1590
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74 LEBANON HWY
-----------------------------------------------------
City | CARTHAGE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37030-2954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. KATHRYN DUBRAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-735-8002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------