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Contact Information

CRMC MSO SUB 1, INCORPORATED
228 W. 4TH STREET
SUITE 200
COOKEVILLE, TN38501
 Phone: 931-372-0405
 Fax: 931-372-0463
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Specialist

174400000X
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for CRMC MSO SUB 1, INCORPORATED

NPI # 1972648319
LBN Legal business name CRMC MSO SUB 1, INCORPORATED
Authorized official MARILYN KEY - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 02/21/2007
Last updated 07/16/2024 - More than a year ago
Identifiers
TN Medicaid 3732135
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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