Organization
PREMIERCARE TENNESSEE INC
Active
Organization
PREMIERCARE TENNESSEE INC
Active
Other names
Ten Broeck Tennessee
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CORDDRY (CHIEF FINANCIAL OFFICER)
(407) 876-2200
Entity
Organization
Contact information
Practice address
1 MEDICAL CENTER BLVD, 5 WEST, COOKEVILLE, TN 38501-4294
(931) 783-2570
(931) 783-2579
Mailing address
603 MAIN ST, WINDERMERE, FL 34786-3548
(407) 876-2200
(407) 876-3065
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
I000000011394
TN
283Q00000X
Psychiatric Hospital
I000000012016
TN
Other
Enumeration date
06/25/2012
Last updated
01/10/2013
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