1215115845 NPI number — GINGER H WARMATH APN

Table of content: GINGER H WARMATH APN (NPI 1215115845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215115845 NPI number — GINGER H WARMATH APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARMATH
Provider First Name:
GINGER
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLLOWAY
Provider Other First Name:
GINGER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215115845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6077 PRIMACY PKWY STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-5742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-725-8347
Provider Business Mailing Address Fax Number:
901-259-7637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6286 BRIARCREST AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-641-3000
Provider Business Practice Location Address Fax Number:
901-701-2400
Provider Enumeration Date:
02/06/2008

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: 163W00000X , with the licence number:  142127 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: APN0000013547 , 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: 620819926 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4272274 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 620819926 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 9826462 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".