1023061520 NPI number — SRHS HOLDINGS LLC

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 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:
Provider Other Organization Name Type Code:
6
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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