1851398960 NPI number — METHODIST HEALTHCARE - FAYETTE HOSPITAL

Table of content: (NPI 1851398960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851398960 NPI number — METHODIST HEALTHCARE - FAYETTE HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHODIST HEALTHCARE - FAYETTE HOSPITAL
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:
1851398960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 UNION AVE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38104-6638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-516-0696
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 LAKEVIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38068-9737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-516-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCLEAN
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
901-516-0696

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  0000000047 , 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: 0440168 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".