Provider Demographics
NPI:1033308960
Name:UNITED NEIGHBORHOOD HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:UNITED NEIGHBORHOOD HEALTH SERVICES, INC
Other - Org Name:WAVERY BELMONT FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUFWACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-228-8902
Mailing Address - Street 1:1501 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4909
Mailing Address - Country:US
Mailing Address - Phone:615-269-3461
Mailing Address - Fax:615-383-1950
Practice Address - Street 1:1501 12TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4909
Practice Address - Country:US
Practice Address - Phone:615-269-3461
Practice Address - Fax:615-383-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3661057Medicaid