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General NPI Number Information
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NPI Number | 1851186720
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Entity Type | Organization
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Legal Business Name | MIDTN INTEGRATIVE THERAPEUTICS, LLC
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Dates
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Enumeration Date | 04/11/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 440 PARK AVE STE D
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City | LEBANON
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State | TN
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Zip | 37087-3665
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Country | US
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Telephone | 518-817-3462
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Fax |
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Provider Business Mailing Address
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Address Line | 200 LOWELL CT
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City | OLD HICKORY
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State | TN
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Zip | 37138-1244
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Country | US
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Telephone | 518-817-3462
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRENT EDWARD FARRIS
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Credential |
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Telephone | 518-817-3462
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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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