1659487494 NPI number — CHILDREN AND ADULTS MEDICAL GROUP, LLC

Table of content: (NPI 1659487494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659487494 NPI number — CHILDREN AND ADULTS MEDICAL GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN AND ADULTS MEDICAL GROUP, 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:
1659487494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/11/2014
NPI Reactivation Date:
10/01/2014

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24730
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:
37202-4730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-222-3331
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4220 HARDING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-222-3331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHATZLEIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
615-284-7847

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65946378 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100164310 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3374470 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".