Provider Demographics
NPI:1396730842
Name:MITTUR N RAMPRASAD MD PC
Entity type:Organization
Organization Name:MITTUR N RAMPRASAD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITTUR
Authorized Official - Middle Name:N
Authorized Official - Last Name:RAMPRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-455-6720
Mailing Address - Street 1:509 NW ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3504
Mailing Address - Country:US
Mailing Address - Phone:931-455-6720
Mailing Address - Fax:931-393-2837
Practice Address - Street 1:509 NW ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3504
Practice Address - Country:US
Practice Address - Phone:931-455-6720
Practice Address - Fax:931-393-2837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000137492085R0202X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0016097OtherBCBST
TN3189056Medicaid
TN3189056Medicaid
B04364Medicare UPIN