Provider Demographics
NPI:1366484032
Name:METRO CENTER HEALTH CARE GROUP PC
Entity Type:Organization
Organization Name:METRO CENTER HEALTH CARE GROUP PC
Other - Org Name:MELVIN W LIGHTFORD MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LIGHTFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-254-9981
Mailing Address - Street 1:131 FRENCH LANDING DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1511
Mailing Address - Country:US
Mailing Address - Phone:615-254-9981
Mailing Address - Fax:615-254-9747
Practice Address - Street 1:131 FRENCH LANDING DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1511
Practice Address - Country:US
Practice Address - Phone:615-254-9981
Practice Address - Fax:615-254-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
TN15942332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4438809OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TN3714012Medicaid
TN3714012Medicaid