1225083819 NPI number — THE HEALTH GROUP OF MCMINNVILLE, P.C.

Table of content: (NPI 1225083819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225083819 NPI number — THE HEALTH GROUP OF MCMINNVILLE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HEALTH GROUP OF MCMINNVILLE, P.C.
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:
1225083819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 HEALTH WAY
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MC MINNVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37110-2658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-473-5394
Provider Business Mailing Address Fax Number:
931-473-6636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 HEALTH WAY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MC MINNVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37110-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-473-5394
Provider Business Practice Location Address Fax Number:
931-473-6636
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLACK
Authorized Official First Name:
PATSY
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
931-473-5394

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD18822 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363L00000X , with the licence number: APN0000005830 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207Q00000X , with the licence number: DO0000001373 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 3347391 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2661043/ CONNECTICUT . This is a "BRYAN CHASTAIN, M.D." identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: MD018822/ LICENSE # . This is a "BRYAN CHASTAIN, M.D." identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: MEDICARE RAILROAD . This is a "P00129995/PIN # DB8149 G" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3844940 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4105481 BC/BS IND # . This is a "HOMER KIRBY, III,D.O." identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3132267 . This is a "CHASTAIN/IND" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: APN05830 LICENSE # . This is a "GRETA MINTON" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4089454 . This is a "GROUP BC/BS NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: DO01373/ LICENSE # . This is a "HOMER E. KIRBY, III, D.O." identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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