Provider Demographics
NPI:1356405278
Name:MATTHEW WALKER COMPREHENSIVE HEALTH CENTER, INC
Entity type:Organization
Organization Name:MATTHEW WALKER COMPREHENSIVE HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-327-9400
Mailing Address - Street 1:1035 14TH AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3050
Mailing Address - Country:US
Mailing Address - Phone:615-340-1292
Mailing Address - Fax:615-327-2806
Practice Address - Street 1:1035 14TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208
Practice Address - Country:US
Practice Address - Phone:615-327-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X, 261Q00000X
TN1308261Q00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4410217OtherNABP
TN3340187Medicaid
TN3340187Medicaid
TN441811Medicare PIN
TN5579220001Medicare NSC
TN33250611Medicare PIN
TN3340187Medicare PIN
3342267Medicare PIN
TN3241268Medicare PIN
TN4410217OtherNABP
TN3814185Medicare PIN
TN38172831Medicare PIN
TN3818313Medicare PIN
TN3070239Medicare PIN
TN3333331Medicare PIN
TN3342276Medicare PIN
TN3340187Medicaid
TN3341467Medicare PIN
TN3351232Medicare PIN
TN38035161Medicare PIN
TN3896594Medicare PIN
TN3076239Medicare PIN
TN3049406Medicare PIN
TN3326053Medicare PIN
TN3072866Medicare PIN