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General NPI Number Information
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NPI Number | 1598073330
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Entity Type | Organization
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Legal Business Name | MDSI, INC.
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 2529 BEECHWOOD DR
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City | ELIZABETHTON
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State | TN
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Zip | 37643-5062
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Country | US
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Telephone | 423-512-1245
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Fax | 423-297-1014
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Provider Business Mailing Address
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Address Line | 2529 BEECHWOOD DR
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City | ELIZABETHTON
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State | TN
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Zip | 37643-5062
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Country | US
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Telephone | 423-512-1245
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Fax | 423-297-1014
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL REEVES MILLER
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Credential |
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Telephone | 423-512-1245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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