NPIMap

Organization Active NPI

Vcphcs Xvii, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Columbia, TN
National Provider Identifier
1508202524
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
VCPHCS XVII, LLC
Practice address
1202 S James Campbell Blvd
Suite 7a
Columbia, TN 38401-5193
Phone
(931) 381-0020
Fax
(931) 381-0029
NPI assigned
May 16, 2013
Last updated
Dec 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Authorized official

Name
Jay Higham
Title
Ceo
Phone
(214) 365-6112

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Methadone Clinic 261QM2800X L000000012587 TN
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU Primary

Addresses

Primary practice location

1202 S James Campbell Blvd
Suite 7a
Columbia, TN 38401-5193

Mailing address

5001 Spring Valley Road
Suite 600 East
Dallas, TX 75244-3946
Phone (214) 365-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190924000441 TN Part B Supplier - Clinic/Group Practice 3375873094 Receives reassigned benefits from 13 practitioners
Practice locations: Columbia, TN
O20200201000059 TN Part B Supplier - Opioid Treatment Program (Otp) 3375873094 Practice locations: Columbia, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2057546Vcphcs Xvii, LLC1202 South James M Campbell Boulevard,Suite# 7a, Columbia, TN 38401Certificate of waiverApr 17, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1368662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735171200000",
    "number": "1508202524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 SPRING VALLEY ROAD",
            "address_2": "SUITE 600 EAST",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752443946",
            "telephone_number": "214-365-6100",
            "fax_number": "214-365-6150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 S JAMES CAMPBELL BLVD",
            "address_2": "SUITE 7A",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384015193",
            "telephone_number": "931-381-0020",
            "fax_number": "931-381-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VCPHCS XVII, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-16",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A",
        "authorized_official_last_name": "HIGHAM",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "214-365-6112"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "TN",
            "license": "L000000012587",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.