| Vcphcs Xvii, Llc | |
|
1202 S James Campbell Blvd Suite 7a Columbia TN 38401-5193 | |
| (931) 381-0020 | |
| (931) 381-0029 |
| Full Name | Vcphcs Xvii, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1202 S James Campbell Blvd, Columbia, Tennessee |
| Authorized Official Name and Position | Jemece Michelle Gasaway (DIRECTOR OF LICENSING) |
| Authorized Official Contact | 2143656126 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vcphcs Xvii, Llc 5001 Spring Valley Road Suite 600 East Dallas TX 75244-3946 Ph: (214) 365-6100 | Vcphcs Xvii, Llc 1202 S James Campbell Blvd Suite 7a Columbia TN 38401-5193 Ph: (931) 381-0020 |
| NPI Number | 1508202524 |
|---|---|
| Provider Enumeration Date | 05/16/2013 |
| Last Update Date | 02/20/2019 |
| Medicare PECOS PAC ID | 3375873094 |
|---|---|
| Medicare Enrollment ID | O20190924000441 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508202524 | NPI | - | NPPES |
| Provider Name | William Alex James |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063494508 PECOS PAC ID: 9638131253 Enrollment ID: I20041027000259 |
| Provider Name | Seth I Kaufman |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1891724738 PECOS PAC ID: 2769562644 Enrollment ID: I20080104000221 |
| Provider Name | Joann S Marrs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104855451 PECOS PAC ID: 9739401720 Enrollment ID: I20141202000930 |
| Provider Name | Nicky D Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336531698 PECOS PAC ID: 0749500544 Enrollment ID: I20150519000959 |
| Provider Name | Molly Ledbetter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184170268 PECOS PAC ID: 7810278710 Enrollment ID: I20170109002167 |
| Provider Name | Jose Luis Lopez-romero |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1659346674 PECOS PAC ID: 2466351762 Enrollment ID: I20170606002383 |
| Provider Name | Brian Edward Fuller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033409438 PECOS PAC ID: 1951616192 Enrollment ID: I20170725002414 |
| Provider Name | Rikki Lynn Pleasants |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659326387 PECOS PAC ID: 1254344708 Enrollment ID: I20200402001070 |
| Provider Name | Ida Santana |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1942483003 PECOS PAC ID: 0941376529 Enrollment ID: I20200413000221 |
| Provider Name | Lisa Torres |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578105870 PECOS PAC ID: 3678995057 Enrollment ID: I20200613000050 |
| Provider Name | Parul V Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194347658 PECOS PAC ID: 6800210238 Enrollment ID: I20200720000153 |
| Provider Name | Jessica Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033725775 PECOS PAC ID: 5496167769 Enrollment ID: I20201209003227 |
| Provider Name | Emily Hahn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811190796 PECOS PAC ID: 3375633589 Enrollment ID: I20210513002040 |
| Provider Name | Raza Hussain |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1891960431 PECOS PAC ID: 0941488217 Enrollment ID: I20210615000598 |
| Provider Name | John Francis O Connell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851479059 PECOS PAC ID: 1759717291 Enrollment ID: I20210812002823 |
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Virginia M. Andrews Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1324 Trotwood Ave Ste 6, Columbia, TN 38401 Phone: 931-223-5711 | |
Alicia A Victory, Psyd, Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 101 Walnut Ln, Columbia, TN 38401 Phone: 615-625-2117 Fax: 865-246-2104 | |
Centerstone Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 321 W 7th St, Columbia, TN 38401 Phone: 931-490-1559 | |
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