Provider Demographics
NPI:1730362468
Name:TREADWAY CLINIC
Entity type:Organization
Organization Name:TREADWAY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:C. RICHARD
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:TREADWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-383-7977
Mailing Address - Street 1:1516 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2906
Mailing Address - Country:US
Mailing Address - Phone:615-383-7977
Mailing Address - Fax:615-298-9606
Practice Address - Street 1:1516 16TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2906
Practice Address - Country:US
Practice Address - Phone:615-383-7977
Practice Address - Fax:615-298-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD67942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716900Medicaid
TN3716900Medicaid
TN3199290Medicare PIN