1215988324 NPI number — MCKENZIE TENNESSEE HOSPITAL COMPANY LLC

Table of content: (NPI 1215988324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215988324 NPI number — MCKENZIE TENNESSEE HOSPITAL COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCKENZIE TENNESSEE HOSPITAL COMPANY 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:
MCKENZIE HOSPITAL CORP ANESTHESIA
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:
1215988324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 COMMERCE WAY
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-2829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC KENZIE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38201-1636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-826-5960
Provider Business Practice Location Address Fax Number:
660-826-4852
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BREWER
Authorized Official First Name:
DEBBIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
DIRECTOR, PROVIDER ENROLLMENT
Authorized Official Telephone Number:
877-892-9813

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3250180 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4121222 . This is a "BCBS GROUP PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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