1992077077 NPI number — CLARKSVILLE PHYSICIAN SERVICES, LLC

Table of content: (NPI 1992077077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992077077 NPI number — CLARKSVILLE PHYSICIAN SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARKSVILLE PHYSICIAN SERVICES, LLC
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:
6
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:
1992077077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3841 GREEN HILLS VILLAGE DR STE 200
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:
37215-2691
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 DR ROBERT H LEE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37058-3750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-232-5141
Provider Business Practice Location Address Fax Number:
931-232-3905
Provider Enumeration Date:
02/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MONACI
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-936-3944

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 44-8914 . This is a "TN-MEDICARE PART A" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com