1104083757 NPI number — DR. PAUL HAYDEN CAUDILL

Table of content: DR. PAUL HAYDEN CAUDILL (NPI 1104083757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104083757 NPI number — DR. PAUL HAYDEN CAUDILL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAUDILL
Provider First Name:
PAUL
Provider Middle Name:
HAYDEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1104083757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3490
Provider Second Line Business Mailing Address:
EMERGENCY MEDICAL CONSULTANTS OF NASHVILLE
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37043-3490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-647-5034
Provider Business Mailing Address Fax Number:
931-552-6663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4220 HARDING PIKE
Provider Second Line Business Practice Location Address:
EMERGENCY MEDICAL CONSULTANTS OF NASHVILLE
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-222-6733
Provider Business Practice Location Address Fax Number:
931-647-5034
Provider Enumeration Date:
05/21/2008

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: 207P00000X , with the licence number:  49702 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 2010-01559 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 159WU . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5915700 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01084145 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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