Provider Demographics
NPI:1144793852
Name:TENNESSEE CENTER OF INTEGRATED MEDICINE
Entity Type:Organization
Organization Name:TENNESSEE CENTER OF INTEGRATED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-919-3833
Mailing Address - Street 1:1832 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6311
Mailing Address - Country:US
Mailing Address - Phone:931-919-3833
Mailing Address - Fax:931-919-3832
Practice Address - Street 1:1832 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6311
Practice Address - Country:US
Practice Address - Phone:931-919-3833
Practice Address - Fax:931-919-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty