Healthcare Provider Details

I. General information

NPI: 1285651182
Provider Name (Legal Business Name): FRIST SCOVILLE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 20TH AVE N 8TH FLOOR
NASHVILLE TN
37203-2131
US

IV. Provider business mailing address

PO BOX 404268
ATLANTA GA
30384-4268
US

V. Phone/Fax

Practice location:
  • Phone: 615-284-1335
  • Fax: 615-284-1316
Mailing address:
  • Phone: 615-284-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000000010
License Number StateTN

VIII. Authorized Official

Name: NEIL M PRICE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 615-284-1335