Basic Information
| Provider Information | |||||||||
| NPI: | 1609161553 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPPER MIDWEST FIRST ASSIST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 CENTERVIEW DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153455390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 214 CENTERVIEW DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153455390 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2011 | ||||||||
| LastUpdateDate: | 06/17/2011 | ||||||||
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| AuthorizedOfficialLastName: | GRAY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | TOBIAS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6153455510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant | 363AS0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.