Healthcare Provider Details

I. General information

NPI: 1487236576
Provider Name (Legal Business Name): SPRINGFIELD HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 04/27/2021
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTHCREST DR
SPRINGFIELD TN
37172-3927
US

IV. Provider business mailing address

100 NORTHCREST DR
SPRINGFIELD TN
37172-3927
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-2411
  • Fax:
Mailing address:
  • Phone: 615-384-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: KENNETH WARD
Title or Position: CFO
Credential:
Phone: 615-384-2411