Basic Information
| Provider Information | |||||||||
| NPI: | 1114317260 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEBBEN PHYSICAL MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 282 CLEAR SKY CT | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370435653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316471199 | ||||||||
| FaxNumber: | 9316477010 | ||||||||
| Practice Location | |||||||||
| Address1: | 282 CLEAR SKY CT | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370435653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9316471199 | ||||||||
| FaxNumber: | 9316477010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2015 | ||||||||
| LastUpdateDate: | 09/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | NEBBEN | ||||||||
| AuthorizedOfficialFirstName: | LOREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9316471199 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 6465 | TN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.