1023079472 NPI number — HALLMARK MEDICAL GROUP

Table of content: DR. STEVEN KENICHI READER PHD (NPI 1184880437)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023079472 NPI number — HALLMARK MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALLMARK MEDICAL GROUP
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:
1023079472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 STONECREST BLVD
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37167-5688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-355-5558
Provider Business Mailing Address Fax Number:
615-355-5644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 STONECREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37167-5688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-355-5558
Provider Business Practice Location Address Fax Number:
615-355-5644
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
EARL
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
615-355-5558

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  137146 , 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)





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