1750699260 NPI number — BLUEFIELD HBP MEDICAL GROUP LLC

Table of content: (NPI 1750699260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750699260 NPI number — BLUEFIELD HBP MEDICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUEFIELD HBP MEDICAL GROUP 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:
1750699260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 COMMERCE WAY
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-2851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-465-3194
Provider Business Mailing Address Fax Number:
615-465-2875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 CHERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24701-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-327-1100
Provider Business Practice Location Address Fax Number:
304-327-7293
Provider Enumeration Date:
09/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VP PHYSICIAN BUSINESS SERVICES
Authorized Official Telephone Number:
615-778-1502

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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