Provider Demographics
NPI:1578617411
Name:SILOAM FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:SILOAM FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAW
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW
Authorized Official - Phone:615-298-5406
Mailing Address - Street 1:820 GALE LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3012
Mailing Address - Country:US
Mailing Address - Phone:615-298-5406
Mailing Address - Fax:615-577-4010
Practice Address - Street 1:820 GALE LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3012
Practice Address - Country:US
Practice Address - Phone:615-298-5406
Practice Address - Fax:615-577-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3726882Medicare ID - Type UnspecifiedGROUP PRICING NUMBER