Provider Demographics
NPI:1790811222
Name:NASHVILLE GASTROENTEROLOGY AND HEPATOLOGY
Entity Type:Organization
Organization Name:NASHVILLE GASTROENTEROLOGY AND HEPATOLOGY
Other - Org Name:SOUTHERN ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FALEECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-390-5053
Mailing Address - Street 1:330 WALLACE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4893
Mailing Address - Country:US
Mailing Address - Phone:615-390-5053
Mailing Address - Fax:615-832-5713
Practice Address - Street 1:330 WALLACE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4893
Practice Address - Country:US
Practice Address - Phone:615-390-5053
Practice Address - Fax:615-832-5713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASHVILLE GSSTROENTEROLOGY AND HEPATOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN490001101OtherRAILROAD MEDICARE PIN
TN490001101OtherRAILROAD MEDICARE PIN