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General NPI Number Information
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NPI Number | 1629630298
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Entity Type | Organization
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Legal Business Name | BORO MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 517 CASON LN STE C
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City | MURFREESBORO
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State | TN
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Zip | 37128-4901
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Country | US
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Telephone | 615-785-8288
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Fax | 615-468-8849
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Provider Business Mailing Address
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Address Line | 268 VETERANS PKWY STE F
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City | MURFREESBORO
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State | TN
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Zip | 37128-6432
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Country | US
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Telephone | 615-785-8288
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Fax | 615-468-8849
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Authorized Official
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Title or Position | OWNER/PA
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Name | LYDIA SEIBERT
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Credential | PA
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Telephone | 615-785-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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