1871596882 NPI number — DAVID A DENEKA M.D.

Table of content: DAVID A DENEKA M.D. (NPI 1871596882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871596882 NPI number — DAVID A DENEKA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENEKA
Provider First Name:
DAVID
Provider Middle Name:
A
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:
1871596882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6077 PRIMACY PKWY STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-5742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-641-3000
Provider Business Mailing Address Fax Number:
901-259-1698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6286 BRIARCREST AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-641-3000
Provider Business Practice Location Address Fax Number:
901-259-1698
Provider Enumeration Date:
05/23/2005

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: 207X00000X , with the licence number:  29319 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: E-7565 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 29319 , 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: 5488613 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7187860 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4081511 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 110318002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3821832 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620819926 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 152563001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00000038768 . This is a "TLC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 008800509 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 620819926 . This is a "BCBS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 620819926 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00164074 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3371161 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6063481 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 620819926 . This is a "TRICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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