Provider Demographics
NPI:1073259735
Name:ESSENTIAL HEALTHCARE GROUP
Entity Type:Organization
Organization Name:ESSENTIAL HEALTHCARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-240-3770
Mailing Address - Street 1:1A BURTON HILLS BOULEVARD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6187
Mailing Address - Country:US
Mailing Address - Phone:615-240-3820
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:9850 GENESEE AVENUE
Practice Address - Street 2:SUITE 820
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1219
Practice Address - Country:US
Practice Address - Phone:858-453-5200
Practice Address - Fax:858-453-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty