1114967684 NPI number — DR. JEFFREY D POOLE D.P.M.

Table of content: DR. JEFFREY D POOLE D.P.M. (NPI 1114967684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114967684 NPI number — DR. JEFFREY D POOLE D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POOLE
Provider First Name:
JEFFREY
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1114967684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3024 BUSINESS PARK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOODLETTSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37072-3132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-851-6033
Provider Business Mailing Address Fax Number:
615-851-2018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 COVEY DR
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-5665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-790-3323
Provider Business Practice Location Address Fax Number:
615-790-6331
Provider Enumeration Date:
06/06/2006

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: 213ES0103X , with the licence number:  DPM0000000636 , 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: 3354148 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103I480472 . This is a "MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 6092884 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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