Provider Demographics
NPI:1164489720
Name:MIDDLE TENNESSEE INTERNAL MEDICINE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE INTERNAL MEDICINE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-833-7080
Mailing Address - Street 1:510 RECOVERY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4878
Mailing Address - Country:US
Mailing Address - Phone:615-833-7080
Mailing Address - Fax:615-833-3163
Practice Address - Street 1:510 RECOVERY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4878
Practice Address - Country:US
Practice Address - Phone:615-833-7080
Practice Address - Fax:615-833-3163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37841207R00000X
TN28385207R00000X
TN29079207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3373765Medicare ID - Type Unspecified