1023146099 NPI number — COLUMBIA PEDIATRIC CLINIC, INC.

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 1023146099 NPI number — COLUMBIA PEDIATRIC CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA PEDIATRIC CLINIC, 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:
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:
1023146099
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:
1222 TROTWOOD AVE
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38401-6436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-388-8965
Provider Business Mailing Address Fax Number:
931-388-0815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1222 TROTWOOD AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401-6436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-388-8965
Provider Business Practice Location Address Fax Number:
931-388-0815
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUNCAN
Authorized Official First Name:
TIFFANY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
931-388-8965

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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