1497822548 NPI number — COLUMBIA MULTI SPECIALTY CLINIC PLLC

Table of content: (NPI 1497822548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497822548 NPI number — COLUMBIA MULTI SPECIALTY CLINIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLUMBIA MULTI SPECIALTY CLINIC PLLC
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:
1497822548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1394 HATCHER LN
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38401-3586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-388-9388
Provider Business Mailing Address Fax Number:
931-388-9808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1394 HATCHER LN
Provider Second Line Business Practice Location Address:
SAME
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401-3586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-388-9388
Provider Business Practice Location Address Fax Number:
931-388-9808
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALI
Authorized Official First Name:
INDU
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
931-388-9388

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0505X , with the licence number: TN LIC # 31656 , 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: 4059771 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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