Provider Demographics
NPI:1831364124
Name:GASTROENTEROLOGY SPECIALISTS OF MIDDLE TENNESSEE LLC
Entity type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS OF MIDDLE TENNESSEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-373-7406
Mailing Address - Fax:
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-831-5422
Practice Address - Fax:615-831-7128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL CORP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-28
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505358Medicaid
TN4180849OtherBCBS
TNDN3097OtherRR MEDICARE
TN1505358Medicaid