Provider Demographics
NPI:1578560785
Name:PRODUCTIVEMD, LLC
Entity Type:Organization
Organization Name:PRODUCTIVEMD, LLC
Other - Org Name:PRODUCTIVEMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-778-0348
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-2027
Mailing Address - Country:US
Mailing Address - Phone:615-778-0348
Mailing Address - Fax:615-778-0470
Practice Address - Street 1:330 MALLORY STATION RD
Practice Address - Street 2:F17
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2859
Practice Address - Country:US
Practice Address - Phone:615-778-0348
Practice Address - Fax:615-778-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3791334Medicare ID - Type Unspecified