Provider Demographics
NPI:1669034955
Name:TENNESSEE CENTER FOR REPRODUCTIVE ACUPUNCTURE
Entity Type:Organization
Organization Name:TENNESSEE CENTER FOR REPRODUCTIVE ACUPUNCTURE
Other - Org Name:MARYVILLE ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JEANE
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:812-219-3302
Mailing Address - Street 1:116 SANDIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-3502
Mailing Address - Country:US
Mailing Address - Phone:812-219-3302
Mailing Address - Fax:
Practice Address - Street 1:423 WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804
Practice Address - Country:US
Practice Address - Phone:865-315-3157
Practice Address - Fax:865-686-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty