1154323749 NPI number — JILL C FICHTEL MD

Table of content: JILL C FICHTEL MD (NPI 1154323749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154323749 NPI number — JILL C FICHTEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FICHTEL
Provider First Name:
JILL
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROWELL
Provider Other First Name:
JILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1154323749
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1909 MALLORY LN STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-905-4994
Provider Business Mailing Address Fax Number:
615-224-6950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1909 MALLORY LN STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-905-4994
Provider Business Practice Location Address Fax Number:
615-224-6950
Provider Enumeration Date:
08/12/2005

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: 207N00000X , with the licence number:  35.122022 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: MD39348 , 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)