Provider Demographics
NPI:1952449605
Name:MID-TENNESSEE MEDICAL ASSOCIATES,PLLC
Entity Type:Organization
Organization Name:MID-TENNESSEE MEDICAL ASSOCIATES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NII
Authorized Official - Middle Name:SABAN
Authorized Official - Last Name:QUAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-287-9499
Mailing Address - Street 1:5242 MURFREESBORO RD
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2714
Mailing Address - Country:US
Mailing Address - Phone:615-287-9499
Mailing Address - Fax:615-793-4032
Practice Address - Street 1:5242 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2714
Practice Address - Country:US
Practice Address - Phone:615-287-9499
Practice Address - Fax:615-793-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD10850OtherMEDICAL LICENSE
TNMD10850OtherMEDICAL LICENSE
TNMD10850OtherMEDICAL LICENSE
TN3184838Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER