Basic Information
Provider Information | |||||||||
NPI: | 1467495796 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TCMC MADISON-PORTLAND, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | TENNESSEE CHRISTIAN MEDICAL CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 277464 | ||||||||
Address2: |   | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 303847464 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6158650300 | ||||||||
FaxNumber: | 6158606447 | ||||||||
Practice Location | |||||||||
Address1: | 500 HOSPITAL DR | ||||||||
Address2: |   | ||||||||
City: | MADISON | ||||||||
State: | TN | ||||||||
PostalCode: | 371155031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6158650300 | ||||||||
FaxNumber: | 6158606447 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MORGAN | ||||||||
AuthorizedOfficialFirstName: | DENISSA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 6157697262 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X |   |   | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 5000106 | 01 | TN | UNITED HEALTH CARE | OTHER | 0440135 | 01 | TN | VANDERBILT HEALTH PLAN | OTHER | 1000151 | 01 | TN | BLUE CROSS | OTHER | 01620517 | 05 | KY |   | MEDICAID | 2294609 | 01 |   | AETNA | OTHER | 048278 | 01 | TN | VALUEOPTIONS | OTHER | 0701589 | 01 |   | CIGNA 440 | OTHER | 1000151 | 01 | TN | TNCARE SELECT | OTHER |