Provider Demographics
NPI:1225083819
Name:THE HEALTH GROUP OF MCMINNVILLE, P.C.
Entity Type:Organization
Organization Name:THE HEALTH GROUP OF MCMINNVILLE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-473-5394
Mailing Address - Street 1:155 HEALTH WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2658
Mailing Address - Country:US
Mailing Address - Phone:931-473-5394
Mailing Address - Fax:931-473-6636
Practice Address - Street 1:155 HEALTH WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2658
Practice Address - Country:US
Practice Address - Phone:931-473-5394
Practice Address - Fax:931-473-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18822207Q00000X
TNDO0000001373207Q00000X
TNAPN0000005830363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3347391Medicaid
TN2661043/ CONNECTICUTOtherBRYAN CHASTAIN, M.D.
TNMD018822/ LICENSE #OtherBRYAN CHASTAIN, M.D.
TNMEDICARE RAILROADOtherP00129995/PIN # DB8149 G
TN3844940Medicaid
TN4105481 BC/BS IND #OtherHOMER KIRBY, III,D.O.
TN3132267OtherCHASTAIN/IND
TNAPN05830 LICENSE #OtherGRETA MINTON
TN4089454OtherGROUP BC/BS NUMBER
TNDO01373/ LICENSE #OtherHOMER E. KIRBY, III, D.O.
TNAPN05830 LICENSE #OtherGRETA MINTON
TN3319259Medicare ID - Type UnspecifiedHOMER KIRBY, III, D.O.
TN4089454OtherGROUP BC/BS NUMBER
TN3132267OtherCHASTAIN/IND
TN3844940Medicare ID - Type UnspecifiedGROUP NUMBER
TNMEDICARE RAILROADOtherP00129995/PIN # DB8149 G
TN3347391Medicaid