Provider Demographics
NPI:1063407856
Name:MIDSTATE HEALTH ASSOCIATES INC
Entity type:Organization
Organization Name:MIDSTATE HEALTH ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ADEWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-329-0494
Mailing Address - Street 1:2201 MURPHY AVE
Mailing Address - Street 2:SUITE # 220
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1835
Mailing Address - Country:US
Mailing Address - Phone:615-329-0494
Mailing Address - Fax:615-515-0205
Practice Address - Street 1:2201 MURPHY AVE
Practice Address - Street 2:SUITE # 220
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1835
Practice Address - Country:US
Practice Address - Phone:615-329-0494
Practice Address - Fax:615-515-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-17
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725544Medicaid
TN3725544Medicare PIN