Basic Information
| Provider Information | |||||||||
| NPI: | 1154422707 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY COMMUNITY HEALTH SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 BENTON AVE | ||||||||
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| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372042303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152929770 | ||||||||
| FaxNumber: | 6152929706 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 BENTON AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372042303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152929770 | ||||||||
| FaxNumber: | 6152929706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 08/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | CUNNINGHAM | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 6159327629 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 3343408 | 05 | TN | MEDICAID |