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NPI Code Detail

MEDICARE: PROVIDE LOCUMS HEALTHCARE PROVIDERS LLC

MEDICARE: PROVIDE LOCUMS HEALTHCARE PROVIDERS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center30027AL

General Provider Information

NPI Number : 1447530480
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDE LOCUMS HEALTHCARE PROVIDERS LLC
Provider Business Mailing Address
First Line : 41 PEABODY ST
Second Line :
City : NASHVILLE
State : TN
Zip : 37210-2125
Country : US
Telephone Number : 423-426-4188
Fax Number :
Provider Business Practice Location Address
First Line : 41 PEABODY ST
Second Line :
City : NASHVILLE
State : TN
Zip : 37210-2125
Country : US
Telephone Number : 423-426-4188
Fax Number :
Authorized Official
Title or Position : MGR
Name : DR. PETER LITCHFIELD
Credential : MD
Telephone Number : 423-426-4188
Provider Enumeration Date : 08/23/2011
Last Update Date : 09/10/2020

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