Provider Demographics
NPI:1194944660
Name:MIDDLE TENNESSEE UROLOGY SPECIALISTS PLLC
Entity type:Organization
Organization Name:MIDDLE TENNESSEE UROLOGY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6915-893-1600
Mailing Address - Street 1:POST OFFICE BOX 7125
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-7125
Mailing Address - Country:US
Mailing Address - Phone:866-220-7391
Mailing Address - Fax:615-261-6052
Practice Address - Street 1:1747 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2563
Practice Address - Country:US
Practice Address - Phone:615-893-1600
Practice Address - Fax:615-225-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0544566208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherEIN
TN=========OtherEIN