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General NPI Number Information
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NPI Number | 1750890174
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Entity Type | Organization
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Legal Business Name | MIDTENN PRIMARY CARE, LLC
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 701 PARK AVE
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City | LEBANON
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State | TN
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Zip | 37087-3724
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Country | US
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Telephone | 615-547-6699
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Fax | 615-547-6692
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Provider Business Mailing Address
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Address Line | 701 PARK AVE
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City | LEBANON
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State | TN
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Zip | 37087-3724
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Country | US
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Telephone | 615-547-6699
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Fax | 615-547-6692
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Authorized Official
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Title or Position | PRESIDENT
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Name | HELEN D FISHER-THORNE
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Credential | APRN
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Telephone | 615-547-6699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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