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NPI Code Detail

MEDICARE: BORDEAUX LABORATORIES INC

MEDICARE: BORDEAUX LABORATORIES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2103TC2200XClinical Child & Adolescent Psychologist
3103TH0004XHealth Psychologist
4133V00000XRegistered Dietitian
5133VN1004XPediatric Nutrition Registered Dietitian
6183500000XPharmacist
7207RE0101XEndocrinology, Diabetes & Metabolism Physician
82080P0205XPediatric Endocrinology Physician
9332900000XNon-Pharmacy Dispensing Site
103336M0002XMail Order Pharmacy
11261Q00000XClinic/Center

General Provider Information

NPI Number : 1033845813
Entity Type Code : Organization
Provider Name (Legal Business Name) : BORDEAUX LABORATORIES INC
Provider Business Mailing Address
First Line : 41 PEABODY ST
Second Line :
City : NASHVILLE
State : TN
Zip : 37210-2125
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 41 PEABODY ST
Second Line :
City : NASHVILLE
State : TN
Zip : 37210-2125
Country : US
Telephone Number : 615-260-0355
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : DONQUATIS MERRIMAN
Credential :
Telephone Number : 615-260-0355
Provider Enumeration Date : 07/25/2022
Last Update Date : 08/15/2022

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Directions to “BORDEAUX LABORATORIES INC ” Practice Location

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