Healthcare Provider Details

I. General information

NPI: 1720679145
Provider Name (Legal Business Name): NORTHSTAR HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 APPLING CARE LN STE 100
CORDOVA TN
38016-4947
US

IV. Provider business mailing address

1540 APPLING CARE LN STE 105
CORDOVA TN
38016-4947
US

V. Phone/Fax

Practice location:
  • Phone: 901-202-0735
  • Fax: 901-800-2487
Mailing address:
  • Phone: 901-378-3561
  • Fax: 901-444-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KELSEY BLEVINS
Title or Position: NATIONAL DIRECTOR OF OPERATIONS
Credential:
Phone: 901-378-3561