Provider Demographics
NPI:1821024530
Name:TENNESSEE SPINE AND NERVE INSTITUTE, PC
Entity Type:Organization
Organization Name:TENNESSEE SPINE AND NERVE INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HALES
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CPC
Authorized Official - Phone:615-352-3000
Mailing Address - Street 1:28 WHITE BRIDGE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1499
Mailing Address - Country:US
Mailing Address - Phone:615-352-3000
Mailing Address - Fax:615-352-6673
Practice Address - Street 1:28 WHITE BRIDGE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1499
Practice Address - Country:US
Practice Address - Phone:615-352-3000
Practice Address - Fax:615-352-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4060581OtherBLUECROSS BLUESHIELD OF TENNESSEE
TN3725278Medicaid
TN3725278Medicaid