1023061520 NPI number — SRHS HOLDINGS LLC

Table of content: (NPI 1023061520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023061520 NPI number — SRHS HOLDINGS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SRHS HOLDINGS LLC
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:
RIVERVIEW REGIONAL MEDICAL CENTER NORTH
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:
1023061520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 HARTSVILLE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLATIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37066-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-328-6695
Provider Business Mailing Address Fax Number:
615-328-6698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
158 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37030-1083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-735-1560
Provider Business Practice Location Address Fax Number:
615-735-5118
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILHOITE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP OF FINANCE & CFO
Authorized Official Telephone Number:
615-328-6695

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0000000130 , 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: 0432599 . This is a "HEALTH SPRINGS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4119897 . This is a "TENNCARE BLUECARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 432599 . This is a "HEALTH SPRING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0440186 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4119897 . This is a "BC OF TN COMMERCIAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4119897 . This is a "TENNCARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: A3703000 . This is a "TENNCARE AMERICHOICE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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