Provider Demographics
NPI:1346440153
Name:LARIMORE C. WARREN, M.D., P.C.
Entity Type:Organization
Organization Name:LARIMORE C. WARREN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARIMORE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-444-3145
Mailing Address - Street 1:1405 W BADDOUR PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2567
Mailing Address - Country:US
Mailing Address - Phone:615-444-3145
Mailing Address - Fax:615-444-3312
Practice Address - Street 1:1405 W BADDOUR PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2567
Practice Address - Country:US
Practice Address - Phone:615-444-3145
Practice Address - Fax:615-444-3312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD15070208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723231Medicaid
TN3723231Medicaid
TN3723231Medicare PIN