Provider Demographics
NPI:1598195539
Name:MEDMD INTERVENTIONAL CARE PC
Entity Type:Organization
Organization Name:MEDMD INTERVENTIONAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-879-8935
Mailing Address - Street 1:314 COOL SPRINGS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6420
Mailing Address - Country:US
Mailing Address - Phone:615-879-8935
Mailing Address - Fax:
Practice Address - Street 1:314 COOL SPRINGS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6420
Practice Address - Country:US
Practice Address - Phone:615-879-8935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF217Medicare PIN
TN103G702622Medicare PIN
NCF215Medicare PIN