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NPI Code Detail

MEDICARE: MID STATE MEDICAL GROUP, LLC

MEDICARE: MID STATE MEDICAL GROUP, LLC
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
1207R00000XInternal Medicine Physician1782TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21093725533OTHERNPI

General Provider Information

NPI Number : 1093725533
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID STATE MEDICAL GROUP, LLC
Provider Business Mailing Address
First Line : PO BOX 309
Second Line :
City : GALLATIN
State : TN
Zip : 37066-0309
Country : US
Telephone Number : 615-230-9095
Fax Number :
Provider Business Practice Location Address
First Line : 1525 HUNT CLUB BLVD
Second Line : SUITE 600
City : GALLATIN
State : TN
Zip : 37066-6070
Country : US
Telephone Number : 615-230-9095
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. NORIDIA MAURAS
Credential : D.O.
Telephone Number : 615-390-0708
Provider Enumeration Date : 08/08/2006
Last Update Date : 02/14/2008

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Directions to “MID STATE MEDICAL GROUP, LLC ” Practice Location

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