Basic Information
| Provider Information | |||||||||
| NPI: | 1194944660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDDLE TENNESSEE UROLOGY SPECIALISTS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | POST OFFICE BOX 7125 | ||||||||
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| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371337125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662207391 | ||||||||
| FaxNumber: | 6152616052 | ||||||||
| Practice Location | |||||||||
| Address1: | 1747 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158931600 | ||||||||
| FaxNumber: | 6152256887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2007 | ||||||||
| LastUpdateDate: | 02/22/2012 | ||||||||
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| AuthorizedOfficialLastName: | BULLOCK | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | FINANCIAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 69158931600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 0544566 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.