Basic Information
| Provider Information | |||||||||
| NPI: | 1487604609 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MURFREESBORO MEDICAL CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1272 GARRISON DR | ||||||||
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| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158934480 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1272 GARRISON DR | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158934480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 09/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | PEAY | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6158677872 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.