Provider Demographics
NPI:1235328485
Name:MIDDLE TENNESSEE LOCUM SERVICES INC
Entity type:Organization
Organization Name:MIDDLE TENNESSEE LOCUM SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:615-702-7060
Mailing Address - Street 1:PO BOX 116331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6331
Mailing Address - Country:US
Mailing Address - Phone:813-287-5718
Mailing Address - Fax:813-287-5728
Practice Address - Street 1:5404 HOOVER BLVD
Practice Address - Street 2:STE 20
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5333
Practice Address - Country:US
Practice Address - Phone:813-287-5718
Practice Address - Fax:813-287-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty