1336121821 NPI number — GOLD SKIN CARE CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336121821 NPI number — GOLD SKIN CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLD SKIN CARE CENTER
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:
1336121821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 RICHARD JONES RD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37215-2885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-383-2400
Provider Business Mailing Address Fax Number:
615-383-1948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 RICHARD JONES RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37215-2885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-383-2400
Provider Business Practice Location Address Fax Number:
615-383-1948
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GOLD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
615-383-2400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 3705441 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com