1942291372 NPI number — THEODORE F RITZER MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942291372 NPI number — THEODORE F RITZER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RITZER
Provider First Name:
THEODORE
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1942291372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
647 DUNLOP LN
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37040-5165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-502-3750
Provider Business Mailing Address Fax Number:
931-502-3755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
647 DUNLOP LN
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37040-5165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-502-3750
Provider Business Practice Location Address Fax Number:
931-502-3755
Provider Enumeration Date:
11/03/2005

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: 207RC0000X , with the licence number:  21394 , 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: 3060334 . This is a "MEDICARE ID - TYPE UNSPECIFIED" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3060335 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4185003 . This is a "BLUE CROSS BLUE SHIELD OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".