Provider Demographics
NPI:1730344060
Name:MEDICAL ASSOCIATES DEVELOPMENT LLC
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES DEVELOPMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-728-6354
Mailing Address - Street 1:1615 MCMINNVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3179
Mailing Address - Country:US
Mailing Address - Phone:931-728-6205
Mailing Address - Fax:931-723-3194
Practice Address - Street 1:1615 MCMINNVILLE HWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3179
Practice Address - Country:US
Practice Address - Phone:931-728-6205
Practice Address - Fax:931-723-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO738208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370342Medicare PIN