Provider Demographics
NPI:1750890174
Name:MIDTENN PRIMARY CARE, LLC
Entity type:Organization
Organization Name:MIDTENN PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FISHER-THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:615-547-6699
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3724
Mailing Address - Country:US
Mailing Address - Phone:615-547-6699
Mailing Address - Fax:615-547-6692
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3724
Practice Address - Country:US
Practice Address - Phone:615-547-6699
Practice Address - Fax:615-547-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care