Provider Demographics
NPI:1194758979
Name:MIDDLE TENNESSEE EMERGENCY PHYSICIANS PC
Entity type:Organization
Organization Name:MIDDLE TENNESSEE EMERGENCY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIX
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:615-688-8160
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-0097
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-623-1227
Practice Address - Street 1:2000 CHURCH STREET
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236
Practice Address - Country:US
Practice Address - Phone:615-284-5555
Practice Address - Fax:615-284-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702105Medicaid
TN3702105Medicaid