Provider Demographics
NPI:1124319454
Name:FISHIELD BEHAVIORAL MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:FISHIELD BEHAVIORAL MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADM
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:STELLA
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-206-7171
Mailing Address - Street 1:801 E OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-4173
Mailing Address - Country:US
Mailing Address - Phone:615-206-7171
Mailing Address - Fax:615-469-0120
Practice Address - Street 1:801 E. OLD HICKORY BLVD.
Practice Address - Street 2:SUITE 160
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-4173
Practice Address - Country:US
Practice Address - Phone:615-206-7171
Practice Address - Fax:615-469-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000013308251S00000X, 251S00000X
TNL000000013307261QM0850X
TNMD0000013877261QP2300X
TN343900000X
TNMD0000048598261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002792Medicaid
TNQ002792Medicaid
TN103G706788Medicare PIN
TN1528970Medicaid