Provider Demographics
NPI:1437299195
Name:STONES RIVER MEDICAL GROUP PC
Entity Type:Organization
Organization Name:STONES RIVER MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOSOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-893-7786
Mailing Address - Street 1:726 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4926
Mailing Address - Country:US
Mailing Address - Phone:615-893-7786
Mailing Address - Fax:615-893-4811
Practice Address - Street 1:726 S. CHURCH STREET
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130
Practice Address - Country:US
Practice Address - Phone:615-893-7786
Practice Address - Fax:615-893-7215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18433174400000X
TNMD7304174400000X
TNCRT0000009482278E1000X
TNRRT00000039342279E1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No2278E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedEducationalGroup - Multi-Specialty
No2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducationalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1558466425OtherB.PAUL TURPIN NPI#
TN3822765OtherMCR INDIV. MARK JOSOVITZ
TN1396827929OtherMARK S.JOSOVITZ NPI
TN3153365OtherM-CAID TURPIN
TN3716276OtherMEDICAID GROUP SRMG
TN3153365OtherM-CAID TURPIN
TN1396827929OtherMARK S.JOSOVITZ NPI
TN1558466425OtherB.PAUL TURPIN NPI#
TND68949Medicare UPIN
TN3153366Medicare ID - Type UnspecifiedINDIV MCR PROV# DR TURPIN
TN3716276OtherMEDICAID GROUP SRMG