1639324056 NPI number — FAMILY WELLNESS GROUP OF MIDDLE TENNESSEE LLC

Table of content: (NPI 1639324056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639324056 NPI number — FAMILY WELLNESS GROUP OF MIDDLE TENNESSEE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY WELLNESS GROUP OF MIDDLE TENNESSEE 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:
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:
1639324056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1558
Provider Second Line Business Mailing Address:
SUMNER REGIONAL HEALTH SYSTEMS INC
Provider Business Mailing Address City Name:
GALLATIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37066-4747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-822-2400
Provider Business Mailing Address Fax Number:
615-822-9641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 GLEN OAK BLVD STE 201
Provider Second Line Business Practice Location Address:
GLEN OAKS CENTER
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37075-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-822-2400
Provider Business Practice Location Address Fax Number:
615-822-9641
Provider Enumeration Date:
11/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
L
Authorized Official Title or Position:
VICE PRESIDENT & FAMILY WELLNESS GR
Authorized Official Telephone Number:
615-328-6600

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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