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General NPI Number Information
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NPI Number | 1962103960
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Entity Type | Organization
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Legal Business Name | BANE MEDICAL MANAGEMENT LLC
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 415 S LINDELL ST
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City | MARTIN
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State | TN
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Zip | 38237-2442
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Country | US
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Telephone | 731-255-5138
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Fax |
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Provider Business Mailing Address
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Address Line | 118 HIDDEN HILL CV
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City | MARTIN
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State | TN
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Zip | 38237-1000
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Country | US
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Telephone | 845-820-0057
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW BANE
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Credential |
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Telephone | 845-820-0057
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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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