Provider Demographics
NPI:1962824482
Name:PLATINUM MEDICAL GROUP
Entity Type:Organization
Organization Name:PLATINUM MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BOOMERSHINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:615-355-0554
Mailing Address - Street 1:515 STONECREST PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6826
Mailing Address - Country:US
Mailing Address - Phone:615-355-0554
Mailing Address - Fax:615-435-3275
Practice Address - Street 1:515 STONECREST PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6826
Practice Address - Country:US
Practice Address - Phone:615-355-0554
Practice Address - Fax:615-435-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38402207R00000X, 207RR0500X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty