Provider Demographics
NPI:1962732149
Name:CENTER FOR INFLAMMATORY DISEASE PC
Entity type:Organization
Organization Name:CENTER FOR INFLAMMATORY DISEASE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGRONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-897-9853
Mailing Address - Street 1:1419 KENSINGTON SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-6939
Mailing Address - Country:US
Mailing Address - Phone:615-396-9080
Mailing Address - Fax:855-744-6439
Practice Address - Street 1:2001 CHARLOTTE AVE STE 102
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2032
Practice Address - Country:US
Practice Address - Phone:615-396-9080
Practice Address - Fax:615-809-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0002X
TN00000047083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122688OtherPK