Provider Demographics
NPI:1063566156
Name:HOSPITALISTS AT CENTENNIAL MEDICAL CENTER LLC
Entity type:Organization
Organization Name:HOSPITALISTS AT CENTENNIAL MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7604
Mailing Address - Street 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-342-6830
Mailing Address - Fax:615-342-6836
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:SUITE 311
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-342-6830
Practice Address - Fax:615-342-6836
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HCA HEALTH SERVICES OF TENNESSEE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDF6685OtherRR MEDICARE
TN3736407Medicaid
TN3736407Medicare PIN