Provider Demographics
NPI:1952509572
Name:COLUMBIA MEDICAL GROUP - THE FRIST CLINIC INC
Entity Type:Organization
Organization Name:COLUMBIA MEDICAL GROUP - THE FRIST CLINIC INC
Other - Org Name:FRIST CLINIC FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7600
Mailing Address - Street 1:111 WEST KINGSTON SPRINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 WEST KINGSTON SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:KINGSTON SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37082
Practice Address - Country:US
Practice Address - Phone:615-792-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBIA MEDICAL GROUP - THE FRIST CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-05
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100024380Medicaid
KY7100032290Medicaid
KY7100032290Medicaid