Basic Information
| Provider Information | |||||||||
| NPI: | 1669567897 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHCREST MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 305172 DEPT 97 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372305172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153841571 | ||||||||
| FaxNumber: | 6153825776 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 NORTHCREST DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371723927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153841571 | ||||||||
| FaxNumber: | 6153825776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | RANDALL | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6153842411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 0000000099 | TN | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 440065 | 01 | TN | OSCAR/MEDICARE | OTHER | 1000141 | 01 | TN | BLUE CROSS ID NUMBER | OTHER |