Provider Demographics
NPI:1740618024
Name:FISHIELD BEHAVIORAL MEDICAL SVCS, INC.
Entity Type:Organization
Organization Name:FISHIELD BEHAVIORAL MEDICAL SVCS, INC.
Other - Org Name:FISHIELD CORP.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. ADM
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:O
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-366-9445
Mailing Address - Street 1:325 PLUS PARK BLVD
Mailing Address - Street 2:101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-1022
Mailing Address - Country:US
Mailing Address - Phone:615-366-9445
Mailing Address - Fax:615-732-0856
Practice Address - Street 1:325 PLUS PARK BLVD
Practice Address - Street 2:101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1022
Practice Address - Country:US
Practice Address - Phone:615-366-9445
Practice Address - Fax:615-732-0856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FISHIELD CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000048598261QM0801X
TNL000000013307261QM0850X
TN1000000013308261QM0850X
TNMD0000013877261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528970Medicaid
TN103G706788Medicare PIN