1366717985 NPI number — TRAYLOR FAMILY HEALTH,LLC

Table of content: (NPI 1366717985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366717985 NPI number — TRAYLOR FAMILY HEALTH,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRAYLOR FAMILY HEALTH,LLC
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:
1366717985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUNNINGHAM
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37052-0128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-206-1161
Provider Business Mailing Address Fax Number:
931-387-3935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5923 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ERIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-206-1161
Provider Business Practice Location Address Fax Number:
931-387-3935
Provider Enumeration Date:
03/14/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TRAYLOR
Authorized Official First Name:
JAMIE
Authorized Official Middle Name:
V
Authorized Official Title or Position:
CHIEF MANAGER/NURSE PRACTITIONER
Authorized Official Telephone Number:
931-206-1161

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  7798 , 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)