Provider Demographics
NPI:1740420538
Name:CENTENNIAL MEDICAL CENTER
Entity Type:Organization
Organization Name:CENTENNIAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:BARBOUR
Authorized Official - Last Name:RHETT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:615-342-5013
Mailing Address - Street 1:330 23RD AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1534
Mailing Address - Country:US
Mailing Address - Phone:615-342-5013
Mailing Address - Fax:615-342-7626
Practice Address - Street 1:330 23RD AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1534
Practice Address - Country:US
Practice Address - Phone:615-342-5013
Practice Address - Fax:615-342-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016790261Q00000X
AL1-116637261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology