Provider Demographics
NPI: | 1124522404 |
---|---|
Name: | DLP TWIN COUNTY PHYSICIAN PRACTICES, LLC |
Entity type: | Organization |
Organization Name: | DLP TWIN COUNTY PHYSICIAN PRACTICES, LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SARA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | MILLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 615-920-7514 |
Mailing Address - Street 1: | 330 SEVEN SPRINGS WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | BRENTWOOD |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37027-5098 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 615-920-7000 |
Mailing Address - Fax: | 615-920-8775 |
Practice Address - Street 1: | 225 HOSPITAL DR |
Practice Address - Street 2: | |
Practice Address - City: | GALAX |
Practice Address - State: | VA |
Practice Address - Zip Code: | 24333-2228 |
Practice Address - Country: | US |
Practice Address - Phone: | 276-236-6906 |
Practice Address - Fax: | 276-236-7179 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-03-21 |
Last Update Date: | 2018-03-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |