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General NPI Number Information
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NPI Number | 1891193041
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Entity Type | Organization
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Legal Business Name | BOSTON MEDICAL GROUP TENNESSEE L.L.C.
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 1916 PATTERSON ST SUITE 715
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City | NASHVILLE
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State | TN
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Zip | 37203
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Country | US
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Telephone | 615-562-4578
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Fax | 423-949-3992
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Provider Business Mailing Address
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Address Line | 23275 S POINTE DRIVE SUITE 100
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City | LAGUNA HILLS
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State | CA
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Zip | 92653
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Country | US
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Telephone | 615-562-4578
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Fax | 423-949-3992
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Authorized Official
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Title or Position | DIRECTOR OF CQRM
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Name | JOAN SIMPSON
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Credential |
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Telephone | 615-562-4578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4878
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License Number State | TN
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