Organization
CRMC MSO SUB 1, INCORPORATED
Active
Other names
Tennessee Heart
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN C KEY (CEO)
(931) 783-2481
Entity
Organization
Contact information
Practice address
228 W. 4TH STREET, SUITE 200, COOKEVILLE, TN 38501
(931) 372-0405
(931) 372-0463
Mailing address
PO BOX 305172, DEPARTMENT 92, NASHVILLE, TN 37230-5172
(931) 372-0405
(931) 372-0463
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
363AS0400X
Surgical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3732135
—
TN
Enumeration date
02/21/2007
Last updated
07/16/2024
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