Provider Demographics
NPI:1659055812
Name:INSTITUTE OF RESTORATIVE MEDICINE TENNESSEE, PLLC
Entity Type:Organization
Organization Name:INSTITUTE OF RESTORATIVE MEDICINE TENNESSEE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:II
Authorized Official - Credentials:DPM
Authorized Official - Phone:615-814-0885
Mailing Address - Street 1:1909 MALLORY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8230
Mailing Address - Country:US
Mailing Address - Phone:615-814-0885
Mailing Address - Fax:615-814-0056
Practice Address - Street 1:1909 MALLORY LN STE 100
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-8230
Practice Address - Country:US
Practice Address - Phone:615-814-0885
Practice Address - Fax:615-814-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty