1154461135 NPI number — HIXSON UROLOGY, PC

Table of content: (NPI 1154461135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154461135 NPI number — HIXSON UROLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIXSON UROLOGY, PC
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:
THOMAS C CALDWELL, MD, PC
Provider Other Organization Name Type Code:
4
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:
1154461135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2051 HAMILL RD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
HIXSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37343-4093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-877-2844
Provider Business Mailing Address Fax Number:
423-877-1959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2051 HAMILL RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HIXSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37343-4093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-877-2844
Provider Business Practice Location Address Fax Number:
423-877-1959
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COHN
Authorized Official First Name:
ROSS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
423-877-2844

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , 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: 3289003 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4160077 . This is a "BLUE CROSS GROUP ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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