Healthcare Provider Details

I. General information

NPI: 1336407147
Provider Name (Legal Business Name): BRADLAKE MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAPLELEAF DRIVE SUITE 200
NASHVILLE TN
37210
US

IV. Provider business mailing address

P.O BOX 148576
NASHVILLE TN
37214
US

V. Phone/Fax

Practice location:
  • Phone: 615-232-7162
  • Fax: 615-232-7308
Mailing address:
  • Phone: 615-232-7162
  • Fax: 615-232-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD0000014656
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD0000014656
License Number StateTN

VIII. Authorized Official

Name: MS. CHINWE C UMEH
Title or Position: MANAGER
Credential:
Phone: 615-232-7162