Organization
THERATECH INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL PRICE (PRESIDENT)
(615) 865-4000
Entity
Organization
Contact information
Practice address
1109 MYATT BLVD, MADISON, TN 37115-2453
(615) 865-4000
(615) 860-5900
Mailing address
1109 MYATT BLVD, MADISON, TN 37115-2453
(615) 865-4000
(615) 860-5900
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0000000716
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009712930
—
AL
05
—
00977545A
—
GA
01
—
01039232
AMERIGROUP
TN
05
—
0440454
—
MS
05
—
100252408-00
—
NE
05
—
1012928
—
VT
05
—
1452177
—
TN
05
—
148218716
—
AR
05
—
200312100A
—
KS
01
—
20454
TLC MEMPHIS MANAGED CARE
TN
01
—
3069828
BLUE CROSS OF TENNESSEE
TN
05
—
90001355
—
KY
05
—
DM0959
—
SC
Enumeration date
05/27/2005
Last updated
01/08/2013
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