=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861118846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAVIDA HEALTH,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2022
-----------------------------------------------------
Last Update Date | 06/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2725 W STATE ST
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37620-1828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-952-0829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 291943
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37229-1943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-952-0829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF REVENUE CYCLE MANAGEMENT
-----------------------------------------------------
Name | MARINA MAHONEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-213-1084
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------