1174519284 NPI number — MRS. DINA H MISHU MD

Table of content: MRS. DINA H MISHU MD (NPI 1174519284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174519284 NPI number — MRS. DINA H MISHU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MISHU
Provider First Name:
DINA
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1174519284
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3103 BUSINESS PARK CIR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOODLETTSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37072-3676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-851-7865
Provider Business Mailing Address Fax Number:
615-851-7853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3103 BUSINESS PARK CIR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOODLETTSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37072-3676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-851-7865
Provider Business Practice Location Address Fax Number:
615-851-7853
Provider Enumeration Date:
09/23/2005

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: 208000000X , with the licence number:  MD19095 , 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: 3127862 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2950507011 . This is a "CIGNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 677740 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1240296 . This is a "UNITED HEALTHCARE HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3038469 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2950507013 . This is a "CIGNA COMM" identifier . This identifiers is of the category "OTHER".




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