1467495796 NPI number — TCMC MADISON-PORTLAND, INC.

Table of content: (NPI 1467495796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467495796 NPI number — TCMC MADISON-PORTLAND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TCMC MADISON-PORTLAND, INC.
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:
TENNESSEE CHRISTIAN MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1467495796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 277464
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-7464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-865-0300
Provider Business Mailing Address Fax Number:
615-860-6447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37115-5031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-865-0300
Provider Business Practice Location Address Fax Number:
615-860-6447
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
DENISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
615-769-7262

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5000106 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0440135 . This is a "VANDERBILT HEALTH PLAN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1000151 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 01620517 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2294609 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 048278 . This is a "VALUEOPTIONS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0701589 . This is a "CIGNA 440" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000151 . This is a "TNCARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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