Provider Demographics
NPI:1093382368
Name:ETMC PHYSICIAN GROUP INC.
Entity Type:Organization
Organization Name:ETMC PHYSICIAN GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-296-3594
Mailing Address - Street 1:1 BURTON HILLS BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6195
Mailing Address - Country:US
Mailing Address - Phone:615-296-3594
Mailing Address - Fax:
Practice Address - Street 1:18118 FM 344 W
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-6010
Practice Address - Country:US
Practice Address - Phone:903-825-3292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health