1679574073 NPI number — TERRELL C ESTES M.D.

Table of content: TERRELL C ESTES M.D. (NPI 1679574073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679574073 NPI number — TERRELL C ESTES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESTES
Provider First Name:
TERRELL
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1679574073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3053 W STATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOL
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37620-1720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-968-1144
Provider Business Mailing Address Fax Number:
423-968-3453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL PARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37620-7430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-968-1144
Provider Business Practice Location Address Fax Number:
423-968-3453
Provider Enumeration Date:
08/09/2005

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: 2085R0202X , with the licence number:  10352 , 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: 300066640 . This is a "PGBA (RR MEDICARE)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7213409 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 94927361 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: R07104 . This is a "JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0213231000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3058518 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3035646 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84799 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com