1104802271 NPI number — JAMES M BACHSTEIN MD

Table of content: JAMES M BACHSTEIN MD (NPI 1104802271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104802271 NPI number — JAMES M BACHSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BACHSTEIN
Provider First Name:
JAMES
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104802271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 BABB DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37087-2506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-466-0041
Provider Business Mailing Address Fax Number:
615-466-0042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 BABB DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37087-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-466-0041
Provider Business Practice Location Address Fax Number:
615-466-0042
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD0000026422 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4002648 . This is a "BC/BS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3092275 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0140598 . This is a "UHC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0678015 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3370236 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4691310-004 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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