Provider Demographics
NPI:1164557856
Name:SOUTHSTREET FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:SOUTHSTREET FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-254-1786
Mailing Address - Street 1:1900 CHURCH ST STE 324
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2234
Mailing Address - Country:US
Mailing Address - Phone:615-730-3758
Mailing Address - Fax:615-726-2961
Practice Address - Street 1:2000 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-4400
Practice Address - Country:US
Practice Address - Phone:615-730-3758
Practice Address - Fax:615-942-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13877305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization