# OLD HICKORY EMERGENCY PHYSICIANS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679771240
- **Authorized official:** JENNIFER PROVASNIK (SUPERVISOR OF PROVIDER ENROLLMENT)
- **Authorized official phone:** (800) 355-0808

## Contact information

- **Practice address:** 500 HOSPITAL DR, MADISON, TN 37115-5031
- **Practice address phone:** (615) 865-0300
- **Practice address fax:** (615) 312-8317
- **Mailing address:** PO BOX 13858, PHILADELPHIA, PA 19101-3858
- **Mailing address phone:** (800) 355-0808
- **Mailing address fax:** (215) 834-2862

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | Yes |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/05/2007
- **Last updated:** 08/22/2020