1154607240 NPI number — HARVEY DURHAM MEDICAL, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154607240 NPI number — HARVEY DURHAM MEDICAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARVEY DURHAM MEDICAL, 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:
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:
1154607240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 SE 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34471-2163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-867-8899
Provider Business Mailing Address Fax Number:
352-867-8864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3443 DICKERSON PIKE
Provider Second Line Business Practice Location Address:
SKYLINE MEDICAL PLAZA, SUITE G-20
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37207-2519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-739-5831
Provider Business Practice Location Address Fax Number:
615-739-5896
Provider Enumeration Date:
11/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KUYKENDALL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATING MANAGER
Authorized Official Telephone Number:
615-815-9851

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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