Provider Demographics
NPI:1851186720
Name:MIDTN INTEGRATIVE THERAPEUTICS, LLC
Entity type:Organization
Organization Name:MIDTN INTEGRATIVE THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-817-3462
Mailing Address - Street 1:200 LOWELL CT
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-1244
Mailing Address - Country:US
Mailing Address - Phone:518-817-3462
Mailing Address - Fax:
Practice Address - Street 1:440 PARK AVE STE D
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3665
Practice Address - Country:US
Practice Address - Phone:518-817-3462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care