MEDICARE: PHYSICIAN SERVICES OF MIDDLE TENNESSEE, 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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1922331842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN SERVICES OF MIDDLE TENNESSEE, LLC

Provider Business Mailing Address
First Line	:	1105 ROLLING CREEK DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-8495
Country	:	US
Telephone Number	:	615-390-6775
Fax Number	:	615-834-2053

Provider Business Practice Location Address
First Line	:	1414 COUNTY HOSPITAL RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37218-3023
Country	:	US
Telephone Number	:	615-862-7000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUTF U REHMAN
Credential	:	MD
Telephone Number	:	615-390-6775

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	09/10/2009

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