Provider Demographics
NPI:1669640728
Name:HERMITAGE MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:HERMITAGE MEDICAL ASSOCIATES PLLC
Other - Org Name:COOL SPRINGS MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:OZENNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-550-6200
Mailing Address - Street 1:740 COOL SPRINGS BLVD.
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6449
Mailing Address - Country:US
Mailing Address - Phone:615-550-6200
Mailing Address - Fax:615-550-6099
Practice Address - Street 1:740 COOL SPRINGS BLVD.
Practice Address - Street 2:SUITE 120
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6449
Practice Address - Country:US
Practice Address - Phone:615-550-6200
Practice Address - Fax:615-550-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3855953Medicaid