Basic Information
| Provider Information | |||||||||
| NPI: | 1487604799 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY HEALTH GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 854 W JAMES CAMPBELL BLVD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384014659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315404255 | ||||||||
| FaxNumber: | 9314904654 | ||||||||
| Practice Location | |||||||||
| Address1: | 5421 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371742499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314862500 | ||||||||
| FaxNumber: | 9314863748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 06/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | PRESTON | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9315404255 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3710082 | 05 | TN | MEDICAID |