1952386401 NPI number — MR. RANDY HOWARD M.D.

Table of content: MR. RANDY HOWARD M.D. (NPI 1952386401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952386401 NPI number — MR. RANDY HOWARD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWARD
Provider First Name:
RANDY
Provider Middle Name:
Provider Name Prefix Text:
MR.
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:
1952386401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 GLEN OAK BLVD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-826-0710
Provider Business Mailing Address Fax Number:
615-826-0910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 GLEN OAK BLVD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-826-0710
Provider Business Practice Location Address Fax Number:
615-826-0910
Provider Enumeration Date:
12/07/2005

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: 207RG0100X , with the licence number:  39358 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: M0000039358 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9398195 . This is a "PHCS PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3983866 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 6591329 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: H90812 . This is a "HEALTHSPRING PROVIDER NUM" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4109554 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 11491546 . This is a "CAQH PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3331737 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: M000039358 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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