Provider Demographics
NPI:1699850180
Name:NORTHCREST MEDICAL CENTER
Entity Type:Organization
Organization Name:NORTHCREST MEDICAL CENTER
Other - Org Name:NORTHCREST HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-384-1501
Mailing Address - Street 1:101E MOORELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-3974
Mailing Address - Country:US
Mailing Address - Phone:615-384-9425
Mailing Address - Fax:615-384-9468
Practice Address - Street 1:101E MOORELAND DRIVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3974
Practice Address - Country:US
Practice Address - Phone:615-384-9425
Practice Address - Fax:615-384-9468
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHCREST MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000521251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN441507Medicare Oscar/Certification