Provider Demographics
NPI:1316773336
Name:MBOC TENNESSEE, P.L.L.C.
Entity type:Organization
Organization Name:MBOC TENNESSEE, P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-822-0691
Mailing Address - Street 1:16 VILLAGE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-2948
Mailing Address - Country:US
Mailing Address - Phone:469-990-3626
Mailing Address - Fax:
Practice Address - Street 1:10904 KINGSTON PIKE STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2952
Practice Address - Country:US
Practice Address - Phone:865-568-5519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MBO TEXAS, P.L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-09
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)