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

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 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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