Provider Demographics
NPI:1427417450
Name:MIDDLE TENNESSEE ADDICTION CLINIC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE ADDICTION CLINIC
Other - Org Name:MIDDLE TENNESSEE ADDICTION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-382-3002
Mailing Address - Street 1:801 HILL ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-2951
Mailing Address - Country:US
Mailing Address - Phone:615-382-3002
Mailing Address - Fax:615-382-2295
Practice Address - Street 1:801 HILL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-2951
Practice Address - Country:US
Practice Address - Phone:615-382-3002
Practice Address - Fax:615-382-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10243261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3180202Medicaid
TN4307400OtherBLUE CROSS
TN4307400OtherBLUE CROSS