Provider Demographics
NPI:1326085747
Name:METROPOLITAN INTERDENOMINATIONAL CHURCH
Entity Type:Organization
Organization Name:METROPOLITAN INTERDENOMINATIONAL CHURCH
Other - Org Name:FIRST RESPONSE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-321-9791
Mailing Address - Street 1:PO BOX 280779
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-0779
Mailing Address - Country:US
Mailing Address - Phone:615-321-9791
Mailing Address - Fax:615-321-9793
Practice Address - Street 1:1223 9TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-2552
Practice Address - Country:US
Practice Address - Phone:615-277-0615
Practice Address - Fax:615-321-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724325Medicaid
TN4087595OtherBCBS
TN3724325Medicare ID - Type Unspecified