Healthcare Provider Details

I. General information

NPI: 1578617411
Provider Name (Legal Business Name): SILOAM FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 GALE LN
NASHVILLE TN
37204-3012
US

IV. Provider business mailing address

820 GALE LN
NASHVILLE TN
37204-3012
US

V. Phone/Fax

Practice location:
  • Phone: 615-298-5406
  • Fax: 615-577-4010
Mailing address:
  • Phone: 615-298-5406
  • Fax: 615-577-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK MCCAW
Title or Position: PROGRAM ADMINISTRATOR
Credential: MSSW
Phone: 615-298-5406