Provider Demographics
NPI:1114317260
Name:NEBBEN PHYSICAL MEDICINE, LLC
Entity Type:Organization
Organization Name:NEBBEN PHYSICAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-647-1199
Mailing Address - Street 1:282 CLEAR SKY CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5653
Mailing Address - Country:US
Mailing Address - Phone:931-647-1199
Mailing Address - Fax:931-647-7010
Practice Address - Street 1:282 CLEAR SKY CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5653
Practice Address - Country:US
Practice Address - Phone:931-647-1199
Practice Address - Fax:931-647-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6465208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G704255Medicare PIN
TN7395690001Medicare NSC