1043209943 NPI number — DR. WILLIAM FARR ANDREWS JR. DDS

Table of content: DR. WILLIAM FARR ANDREWS JR. DDS (NPI 1043209943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043209943 NPI number — DR. WILLIAM FARR ANDREWS JR. DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREWS
Provider First Name:
WILLIAM
Provider Middle Name:
FARR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DDS
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:
1043209943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 BOLIVAR HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38301-7810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-423-2278
Provider Business Mailing Address Fax Number:
731-424-6131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 BOLIVAR HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38301-7810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-423-2278
Provider Business Practice Location Address Fax Number:
731-424-6131
Provider Enumeration Date:
10/14/2005

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: 1223G0001X , with the licence number:  DS2510 , 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: 2002169 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3217683 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".