PS Maryland Iom, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

PS MARYLAND IOM, LLC

Practice address

700 12TH Ave S
Suite 306
Nashville, TN 37203-3367

Phone

(877) 977-4630

Fax

(615) 457-1447

NPI assigned

Dec 17, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brian McCollum

Title

President & Ceo

Phone

(877) 396-3161

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441843200000",
    "number": "1043618432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 680835",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370680835",
            "telephone_number": "877-396-3161",
            "fax_number": "615-457-1447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 12TH AVE S",
            "address_2": "SUITE 306",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372033367",
            "telephone_number": "877-977-4630",
            "fax_number": "615-457-1447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PS MARYLAND IOM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-17",
        "last_updated": "2015-09-10",
        "status": "A",
        "authorized_official_last_name": "MCCOLLUM",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "877-396-3161",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Nashville, TN
• Providers in Nashville, TN by specialty
• Medical Specialty Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.