Basic Information
| Provider Information | |||||||||
| NPI: | 1992718688 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT THOMAS HICKMAN HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ASCENSION SAINT THOMAS HICKMAN MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 20TH AVE N STE 403 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372035180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152893257 | ||||||||
| FaxNumber: | 6156734541 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 E SWAN STREET | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317293091 | ||||||||
| FaxNumber: | 9317290809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6152846845 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SAINT THOMAS HICKMAN HOSPITAL | ||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 4037834 | 01 | TN | BCBS PROF | OTHER | 4057064 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 0443435 | 05 | TN | MEDICAID | 3280569 | 01 | TN | MEDICARE PTAN | OTHER |