Basic Information
| Provider Information | |||||||||
| NPI: | 1053779587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEAM HEALTH USA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1011 PARIS RD | ||||||||
| Address2: | SUITE 341 | ||||||||
| City: | MAYFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420663306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702510907 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1011 PARIS RD | ||||||||
| Address2: | SUITE 341 | ||||||||
| City: | MAYFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420663306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702510907 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2016 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2702510907 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3010068 | KY | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.