Provider Demographics
NPI:1760615850
Name:MIDDLE TENNESSEE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE MANAGEMENT, LLC
Other - Org Name:LEWISBURG FAMILY DENISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-327-9944
Mailing Address - Street 1:113 THE ACRES
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2845
Mailing Address - Country:US
Mailing Address - Phone:931-359-7004
Mailing Address - Fax:931-359-0951
Practice Address - Street 1:113 THE ACRES
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2845
Practice Address - Country:US
Practice Address - Phone:931-359-7004
Practice Address - Fax:931-359-0951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512331Medicaid