Basic Information
| Provider Information | |||||||||
| NPI: | 1477550283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CREECH | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | HAZARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 MERIDIAN SPRINGS DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383015900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312560526 | ||||||||
| FaxNumber: | 7312561720 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 MERIDIAN SPRINGS DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383015900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7312560526 | ||||||||
| FaxNumber: | 7312561720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 11/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 24799 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 332B00000X | MD024799 | TN | N | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 33809 | 01 | TN | TLC | OTHER | 626001636 | 01 | TN | USA MANAGED CARE | OTHER | P00223670 | 01 | TN | RAILROAD MEDICARE | OTHER | 4099359 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 162154 | 01 | TN | BETTER HEALTH | OTHER | 0725896 | 01 | TN | CIGNA | OTHER | 626001636 | 01 | TN | HEALTH PARTNERS | OTHER | 3078636 | 05 | TN | MEDICAID | 626001636 | 01 | TN | UNITED HEALTHCARE | OTHER |