Provider Demographics
NPI:1598021784
Name:MID- TN THERAPEUTIC CLINIC
Entity Type:Organization
Organization Name:MID- TN THERAPEUTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FISHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-907-9771
Mailing Address - Street 1:2246 KEENLAND COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-3909
Mailing Address - Country:US
Mailing Address - Phone:615-907-9771
Mailing Address - Fax:615-907-9545
Practice Address - Street 1:2246 KEENLAND COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-3909
Practice Address - Country:US
Practice Address - Phone:615-907-9771
Practice Address - Fax:615-907-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD013323207X00000X
TNAPN0000006108363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty