Basic Information
| Provider Information | |||||||||
| NPI: | 1366484032 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METRO CENTER HEALTH CARE GROUP PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MELVIN W LIGHTFORD MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 131 FRENCH LANDING DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152549981 | ||||||||
| FaxNumber: | 6152549747 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 FRENCH LANDING DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152549981 | ||||||||
| FaxNumber: | 6152549747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LIGHTFORD | ||||||||
| AuthorizedOfficialFirstName: | MELVIN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRINCIPAL | ||||||||
| AuthorizedOfficialTelephone: | 6152549981 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | 15942 | TN | N | Suppliers | Non-Pharmacy Dispensing Site | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4438809 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER | 3714012 | 05 | TN | MEDICAID |