Provider Demographics
NPI:1891850780
Name:RICHLAND INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:RICHLAND INTERNAL MEDICINE LLC
Other - Org Name:URGENT CARE AT PROVIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-284-6861
Mailing Address - Street 1:PO BOX 24730
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202-4730
Mailing Address - Country:US
Mailing Address - Phone:615-386-2300
Mailing Address - Fax:615-386-2399
Practice Address - Street 1:5002 CROSSING CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122
Practice Address - Country:US
Practice Address - Phone:615-595-9111
Practice Address - Fax:615-758-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374407Medicaid
TN3374407Medicare ID - Type UnspecifiedMEDICARE PROVIDER #