1205830536 NPI number — DR. FERNANDO BENDFELDT M.D.

Table of content: DR. FERNANDO BENDFELDT M.D. (NPI 1205830536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205830536 NPI number — DR. FERNANDO BENDFELDT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENDFELDT
Provider First Name:
FERNANDO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1205830536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37602-5725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-283-8801
Provider Business Mailing Address Fax Number:
423-282-4533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MED TECH PKWY
Provider Second Line Business Practice Location Address:
STE 407
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-283-8801
Provider Business Practice Location Address Fax Number:
423-282-4533
Provider Enumeration Date:
05/23/2005

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: 2084N0400X , with the licence number:  MD09195 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0805X , with the licence number: MD09195 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: MD09195 , 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: 219709 . This is a "TRIGON BC/BS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 260046091 . This is a "PALMETTO GBA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 621837879-0002 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3036274 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 621837879-01 . This is a "JOHN DEERE HEALTH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7104511 . This is a "MEDICAID VA7104511" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1205830536 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3159564 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 421837879 . This is a "CARITEN SENIOR HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 621837879 . This is a "AIG CLAIM SVS WORKER COM" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 621837879 . This is a "INITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 621837879 . This is a "CM ADMINISTRATORS IN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 621837879 . This is a "CBHA CAROLINA BEHAVIORAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 621837879 . This is a "HORIZON HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 621837879 . This is a "AMERICAN GENERAL LIFE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 621837879 . This is a "BANKERS LIFE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: NPI , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21699743 . This is a "GEHA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1205830536 . This is a "NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 621837870 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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