Provider Demographics
NPI:1497942569
Name:INTERNAL MEDICINE SPECALISTS OF MIDDLE TENNESSEE
Entity Type:Organization
Organization Name:INTERNAL MEDICINE SPECALISTS OF MIDDLE TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:STENSBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-967-5646
Mailing Address - Street 1:186 HOSPITAL RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2472
Mailing Address - Country:US
Mailing Address - Phone:931-967-5646
Mailing Address - Fax:931-967-9082
Practice Address - Street 1:186 HOSPITAL RD
Practice Address - Street 2:SUITE 500
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2472
Practice Address - Country:US
Practice Address - Phone:931-967-5646
Practice Address - Fax:931-967-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723665Medicaid
TN3723665Medicaid
TN3723665Medicare PIN