Provider Demographics
NPI:1740497593
Name:THERATECH HOLDINGS
Entity type:Organization
Organization Name:THERATECH HOLDINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-8220
Mailing Address - Street 1:40 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6155
Mailing Address - Country:US
Mailing Address - Phone:615-665-8220
Mailing Address - Fax:615-665-8228
Practice Address - Street 1:40 BURTON HILLS BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-6155
Practice Address - Country:US
Practice Address - Phone:615-665-8220
Practice Address - Fax:615-665-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7129885Medicaid
WAP00289319OtherRAILROAD MEDICARE
WAG8803389Medicare ID - Type Unspecified