Provider Demographics
NPI:1366108102
Name:360 INTEGRATED CARE PC
Entity type:Organization
Organization Name:360 INTEGRATED CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-868-8612
Mailing Address - Street 1:1210 BRIARVILLE RD.
Mailing Address - Street 2:BLDG B
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115
Mailing Address - Country:US
Mailing Address - Phone:615-868-8612
Mailing Address - Fax:615-860-4510
Practice Address - Street 1:1210 BRIARVILLE RD.
Practice Address - Street 2:BLDG B
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-868-8612
Practice Address - Fax:615-860-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty