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General NPI Number Information
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NPI Number | 1942480611
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Entity Type | Organization
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Legal Business Name | MEDTRACK, LLC
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 28 WHITE BRIDGE RD STE 108
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City | NASHVILLE
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State | TN
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Zip | 37205-1466
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Country | US
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Telephone | 615-352-1212
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Fax | 615-352-1215
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Provider Business Mailing Address
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Address Line | PO BOX 610
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City | GOODLETTSVILLE
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State | TN
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Zip | 37070-0610
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Country | US
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Telephone | 615-352-1212
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Fax | 615-352-1215
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Authorized Official
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Title or Position | OWNER
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Name | JOHN ABNER SAVAGE JR.
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Credential | CRNA
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Telephone | 615-352-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 100002
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License Number State | TN
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