1073516340 NPI number — DR. MARK TEDDER M.D.

Table of content: DR. MARK TEDDER M.D. (NPI 1073516340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073516340 NPI number — DR. MARK TEDDER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEDDER
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
1073516340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 GREAT CIRCLE RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37228-1317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-222-7685
Provider Business Mailing Address Fax Number:
615-222-7237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4230 HARDING PIKE
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-385-4781
Provider Business Practice Location Address Fax Number:
615-385-9265
Provider Enumeration Date:
05/31/2005

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: 208G00000X , with the licence number:  MD029206 , 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: 4334022 . This is a "BCBST" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P01004440 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3812958 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0995624 . This is a "AETNA HMO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1840022 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 01616927 . This is a "AMERIGROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5463506 . This is a "AETNA PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8773249003 . This is a "CIGNA PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8773249004 . This is a "CIGNA HMO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com