Healthcare Provider Details

I. General information

NPI: 1356592612
Provider Name (Legal Business Name): MEADOWVIEW PHYSICIAN PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 MEDICAL PARK DR SUITE 201
MAYSVILLE KY
41056
US

IV. Provider business mailing address

330 SEVEN SPRINGS WAY
BRENTWOOD TN
37027-5098
US

V. Phone/Fax

Practice location:
  • Phone: 615-957-0847
  • Fax:
Mailing address:
  • Phone: 615-920-7000
  • Fax: 615-920-8775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30189
License Number StateKY

VIII. Authorized Official

Name: KATHY TEAGUE
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 615-920-7000