1972794501 NPI number — DAMASCUS HEALTH AND FAMILY WELLNESS CENTER, PC

Table of content: (NPI 1972794501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972794501 NPI number — DAMASCUS HEALTH AND FAMILY WELLNESS CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAMASCUS HEALTH AND FAMILY WELLNESS CENTER, PC
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:
1972794501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 331268
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-7512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-329-3535
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3109 JOHN A MERRITT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37209-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-329-3535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RILEY-BURT
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
PRESIDENT, CEO
Authorized Official Telephone Number:
615-329-3535

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  040904 , 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)





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