Organization
NORTHCREST PHYSICIAN SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERLYN S DAVIS (BILLER)
(615) 382-5710
Entity
Organization
Contact information
Practice address
417 NORTHCREST DR, 430 NORTHCREST DR, SPRINGFIELD, TN 37172-3973
(615) 382-5710
(615) 382-5776
Mailing address
PO BOX 969, SPRINGFIELD, TN 37172-0969
(615) 382-5710
(615) 382-5776
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
24985
TN
207R00000X
Internal Medicine Physician
31309
TN
207R00000X
Internal Medicine Physician
Primary
MD6465
TN
207X00000X
Orthopaedic Surgery Physician
31565
TN
207X00000X
Orthopaedic Surgery Physician
37667
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3371051
MEDICARE GROUP NUMBER
TN
01
—
3709970
MEDICARE GROUP NUMBER
TN
01
—
3709979
MEDICARE GROUP NUMBER
TN
Enumeration date
04/26/2007
Last updated
10/28/2008
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