Provider Demographics
NPI:1013062108
Name:JOHN L STANTON MD
Entity Type:Organization
Organization Name:JOHN L STANTON MD
Other - Org Name:JOHN L STANTON MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMIKKA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-905-1001
Mailing Address - Street 1:331 LANDRUM PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6319
Mailing Address - Country:US
Mailing Address - Phone:931-905-1001
Mailing Address - Fax:931-905-0410
Practice Address - Street 1:307 E MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061
Practice Address - Country:US
Practice Address - Phone:931-905-1001
Practice Address - Fax:931-905-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28572332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4695470001OtherDURABLE MEDICAL
TN3376845Medicaid
TN4695470001OtherDURABLE MEDICAL
TN3376845Medicare PIN