Basic Information
| Provider Information | |||||||||
| NPI: | 1902972094 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TENNESSEE LITHOTRIPSY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 COVEY DR | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370675665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157901660 | ||||||||
| FaxNumber: | 6157903705 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 COVEY DR | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370675665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157901660 | ||||||||
| FaxNumber: | 6157903705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOCKE | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6157901660 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.