Provider Demographics
NPI:1982897641
Name:LIMESTONE MEDICAL CARE LLC
Entity Type:Organization
Organization Name:LIMESTONE MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOUSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:NASERI
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-257-8382
Mailing Address - Street 1:533 BIG LIMESTONE RD.
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681
Mailing Address - Country:US
Mailing Address - Phone:423-257-8382
Mailing Address - Fax:
Practice Address - Street 1:533 BIG LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:TN
Practice Address - Zip Code:37681-2537
Practice Address - Country:US
Practice Address - Phone:423-257-8382
Practice Address - Fax:423-257-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6456261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS60041Medicare UPIN