Provider Demographics
NPI:1629071352
Name:THERATECH INC
Entity Type:Organization
Organization Name:THERATECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-865-4000
Mailing Address - Street 1:1109 MYATT BLVD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2453
Mailing Address - Country:US
Mailing Address - Phone:615-865-4000
Mailing Address - Fax:615-860-5900
Practice Address - Street 1:1109 MYATT BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2453
Practice Address - Country:US
Practice Address - Phone:615-865-4000
Practice Address - Fax:615-860-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000716332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN01039232OtherAMERIGROUP
VT1012928Medicaid
TN1452177Medicaid
KS200312100AMedicaid
MS0440454Medicaid
NE100252408-00Medicaid
SCDM0959Medicaid
TN20454OtherTLC MEMPHIS MANAGED CARE
TN3069828OtherBLUE CROSS OF TENNESSEE
AR148218716Medicaid
KY90001355Medicaid
AL009712930Medicaid
GA00977545AMedicaid
AL009712930Medicaid
AR148218716Medicaid
AL009712930Medicaid