1134306244 NPI number — VANDERBILT ASTHMA SINUS AND ALLERGY PROGRAM, LLC

Table of content: MARIAN ELIZABETH PLANTE HANLON (NPI 1477359131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134306244 NPI number — VANDERBILT ASTHMA SINUS AND ALLERGY PROGRAM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VANDERBILT ASTHMA SINUS AND ALLERGY PROGRAM, LLC
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:
6
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:
1134306244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 262
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38101-0262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-936-2727
Provider Business Mailing Address Fax Number:
615-936-5862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2611 WEST END AVENUE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-936-2727
Provider Business Practice Location Address Fax Number:
615-936-5862
Provider Enumeration Date:
01/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BARKSDALE
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER PHYSICIAN BILLING SERVICES
Authorized Official Telephone Number:
615-936-2727

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PENDING , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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