1356561856 NPI number — NORTHCREST PHYSICIAN SERVICES INC

Table of content: (NPI 1356561856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356561856 NPI number — NORTHCREST PHYSICIAN SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHCREST PHYSICIAN SERVICES 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:
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:
1356561856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 969
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37172-0969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-382-5710
Provider Business Mailing Address Fax Number:
615-382-5776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 NORTHCREST DR
Provider Second Line Business Practice Location Address:
430 NORTHCREST DR
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37172-3973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-382-5710
Provider Business Practice Location Address Fax Number:
615-382-5776
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
JERLYN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
615-382-5710

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  24985 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 31309 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD6465 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207X00000X , with the licence number: 37667 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 31565 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3709970 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3371051 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3709979 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com