1497761720 NPI number — MATTHEW BULOW C.P.

Table of content: MATTHEW BULOW C.P. (NPI 1497761720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497761720 NPI number — MATTHEW BULOW C.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULOW
Provider First Name:
MATTHEW
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.P.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DYE
Provider Other First Name:
DAVID
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MANAGER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1497761720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
708 E 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38501-1958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-520-0244
Provider Business Mailing Address Fax Number:
931-520-0241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 E 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-520-0244
Provider Business Practice Location Address Fax Number:
931-520-0241
Provider Enumeration Date:
07/31/2006

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: 1744P3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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