1215987938 NPI number — SAMEH WARD M.D.

Table of content: SAMEH WARD M.D. (NPI 1215987938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215987938 NPI number — SAMEH WARD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARD
Provider First Name:
SAMEH
Provider Middle Name:
Provider Name Prefix Text:
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:
1215987938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 MED TECH PKWY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604-4001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-232-6120
Provider Business Mailing Address Fax Number:
423-232-6125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 MED TECH PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-232-6120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2006

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: 208VP0014X , with the licence number:  MD0000031480 , 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: 147002 . This is a "ANTHEM PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 13547 . This is a "CARITEN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 9369903 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0113 . This is a "JOHN DEERE KINGSPORT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 147001 . This is a "ANTHEM PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00072297 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7269213 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 010063736 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4039257 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 146999 . This is a "ANTHEM PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3877225 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: TN0114 . This is a "JOHN DEERE JOHNSON CITY" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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