Provider Demographics
NPI:1437307535
Name:MIDDLE TENNESSEE NEPHROLOGY
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE NEPHROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:MATHEWS
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-452-3250
Mailing Address - Street 1:270 EAST MAIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-452-3250
Mailing Address - Fax:615-452-5186
Practice Address - Street 1:270 EAST MAIN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-452-3250
Practice Address - Fax:615-452-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38656207RN0300X
OH84048207RN0300X
TN43872207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3002519Medicare PIN