Provider Demographics
NPI:1598546210
Name:WAYSPRING CLINIC IA LLC
Entity Type:Organization
Organization Name:WAYSPRING CLINIC IA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-345-3555
Mailing Address - Street 1:209 10TH AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4166
Mailing Address - Country:US
Mailing Address - Phone:615-345-3555
Mailing Address - Fax:
Practice Address - Street 1:209 10TH AVE S STE 350
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-4166
Practice Address - Country:US
Practice Address - Phone:615-345-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WAYSPRING CLINIC IA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty