1588656508 NPI number — SAINT THOMAS CAMPUS SURGICARE LP

Table of content: (NPI 1588656508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588656508 NPI number — SAINT THOMAS CAMPUS SURGICARE LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT THOMAS CAMPUS SURGICARE LP
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:
1588656508
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4230 HARDING PIKE
Provider Second Line Business Mailing Address:
PLAZA EAST, SUITE 300
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-2013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-783-1261
Provider Business Mailing Address Fax Number:
615-783-1261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4230 HARDING PIKE
Provider Second Line Business Practice Location Address:
PLAZA EAST, SUITE 300
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-783-1260
Provider Business Practice Location Address Fax Number:
615-783-1261
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MORAN
Authorized Official First Name:
JENETHA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
972-763-3893

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0000000143 , 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: 4042363 . This is a "BLUE CROSS BLUE SHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3288708 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490005604 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0430591 . This is a "HEALTHSPRINGS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 103660100 . This is a "U.S. DEPT OF LABOR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2890510 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 36001295 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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