Healthcare Provider Details

I. General information

NPI: 1740420538
Provider Name (Legal Business Name): CENTENNIAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 23RD AVE N
NASHVILLE TN
37203-1534
US

IV. Provider business mailing address

330 23RD AVE N
NASHVILLE TN
37203-1534
US

V. Phone/Fax

Practice location:
  • Phone: 615-342-5013
  • Fax: 615-342-7626
Mailing address:
  • Phone: 615-342-5013
  • Fax: 615-342-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number1-116637
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAPN0000016790
License Number StateTN

VIII. Authorized Official

Name: MISS SHARON BARBOUR RHETT
Title or Position: CRNP
Credential: MSN
Phone: 615-342-5013