Provider Demographics
NPI:1083650659
Name:TENNESSEE ELECTRO NEURO DIAGNOSTICS
Entity type:Organization
Organization Name:TENNESSEE ELECTRO NEURO DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:CNIM
Authorized Official - Phone:615-397-2456
Mailing Address - Street 1:PO BOX 293296
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-3296
Mailing Address - Country:US
Mailing Address - Phone:615-397-2456
Mailing Address - Fax:615-885-3691
Practice Address - Street 1:3224 NEWINGTON CV
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2537
Practice Address - Country:US
Practice Address - Phone:615-397-2456
Practice Address - Fax:615-885-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN380246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty