1508866898 NPI number — COMMUNITY CARE OF RUTHERFORD COUNTY, INC.

Table of content: (NPI 1508866898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508866898 NPI number — COMMUNITY CARE OF RUTHERFORD COUNTY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY CARE OF RUTHERFORD COUNTY, 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:
1508866898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 EAST COUNTY FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37127-6328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-893-2624
Provider Business Mailing Address Fax Number:
615-898-7989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901EAST COUNTY FARM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37127-6328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-893-2624
Provider Business Practice Location Address Fax Number:
615-898-7989
Provider Enumeration Date:
07/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
615-893-2624

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0000000219 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , 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: 7440175 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0445406 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4100484 . This is a "BLUECROSS ALLIED PROVIDER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3110468 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".