Provider Demographics
NPI:1992069538
Name:CAH ACQUISITION COMPANY 11 LLC
Entity type:Organization
Organization Name:CAH ACQUISITION COMPANY 11 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-221-2200
Mailing Address - Street 1:326 ASBURY AVE
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-5577
Mailing Address - Country:US
Mailing Address - Phone:731-221-2200
Mailing Address - Fax:731-221-2499
Practice Address - Street 1:326 ASBURY AVE
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063
Practice Address - Country:US
Practice Address - Phone:731-221-2200
Practice Address - Fax:731-221-2499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAH ACQUISITION COMPANY 11 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-28
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0088208600000X, 207P00000X, 207R00000X, 208M00000X, 363A00000X, 363L00000X, 367500000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530950Medicaid
TN103G700356Medicare Oscar/Certification