Provider Demographics
NPI:1669575858
Name:COLUMBIA MEDICAL GROUP-CENTENNIAL INC
Entity type:Organization
Organization Name:COLUMBIA MEDICAL GROUP-CENTENNIAL INC
Other - Org Name:
Other - Org Type:
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 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-342-5626
Mailing Address - Fax:615-342-5635
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:SUITE 115
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-342-5626
Practice Address - Fax:615-342-5635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHSERV ACQUISITION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3715626Medicaid
TN3715626Medicare PIN
TN3715626Medicaid