1346419751 NPI number — WILLIAM VAN BINGHAM, M.D., P.C.

Table of content: (NPI 1346419751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346419751 NPI number — WILLIAM VAN BINGHAM, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM VAN BINGHAM, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1346419751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6005 PARK AVE
Provider Second Line Business Mailing Address:
SUITE 803
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-5202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-683-0642
Provider Business Mailing Address Fax Number:
901-881-6011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6005 PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 803
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-5202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-683-0642
Provider Business Practice Location Address Fax Number:
901-881-6011
Provider Enumeration Date:
02/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BINGHAM
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
VAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
901-683-0642

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  34970 , 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: 4037497001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3862008 . This is a "MEDICARE INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7703236 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1940206 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4083525 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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