Provider Demographics
NPI:1285795278
Name:HEALING PLACE FAMILY MEDICINE
Entity type:Organization
Organization Name:HEALING PLACE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:615-851-8959
Mailing Address - Street 1:824 WREN RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2312
Mailing Address - Country:US
Mailing Address - Phone:615-851-8959
Mailing Address - Fax:615-851-5949
Practice Address - Street 1:824 WREN RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2312
Practice Address - Country:US
Practice Address - Phone:615-851-8959
Practice Address - Fax:615-851-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
9842836002OtherCIGNA
TN0102OtherAMERICHOICE
4147626OtherBCBS
G58444OtherHEALTHSPRINGS
TN01035857OtherAMERIGROUP
4152576OtherBCBS
G20365OtherHEALTHSPRINGS
TN0101OtherAMERICHOICE
7197644OtherAETNA
01041710OtherAMERIGROUP
1790899508OtherNPI RONALD MCDERMOTT M.D.
6271922OtherCIGNA
7078597OtherAETNA
1285795278OtherGROUP NPI
TN3094940Medicaid
TN3818316Medicaid
TN4147623OtherBCBS
6271922OtherCIGNA
7078597OtherAETNA
TN0102OtherAMERICHOICE
01041710OtherAMERIGROUP
6271922OtherCIGNA
TNG20365Medicare UPIN