1184870578 NPI number — OMNI COMMUNITY HEALTH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184870578 NPI number — OMNI COMMUNITY HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMNI COMMUNITY HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184870578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 S. PERIMETER PARK DRIVE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37211-4128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-726-3603
Provider Business Mailing Address Fax Number:
614-827-0421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 MALLORY LANE
Provider Second Line Business Practice Location Address:
SUITE 300-B
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-8236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-224-1590
Provider Business Practice Location Address Fax Number:
615-224-1595
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JUST
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
615-726-3603

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  3074 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q019926 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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