MEDICARE: MIDDLE TENNESSEE MEDICAL 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
1	363LF0000X	Family Nurse Practitioner
2	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1508991456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDDLE TENNESSEE MEDICAL INC.

Provider Business Mailing Address
First Line	:	6011 TROTWOOD AVE
Second Line	:	SUITE 400
City	:	COLUMBIA
State	:	TN
Zip	:	38401-7009
Country	:	US
Telephone Number	:	931-388-9663
Fax Number	:	931-388-7411

Provider Business Practice Location Address
First Line	:	6011 TROTWOOD AVE
Second Line	:	SUITE 400
City	:	COLUMBIA
State	:	TN
Zip	:	38401-7009
Country	:	US
Telephone Number	:	931-388-9663
Fax Number	:	931-388-7411

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	MRS. CHRISTY MORTON MASH
Credential	:
Telephone Number	:	931-388-9663

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/06/2010

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