1295760981 NPI number — DR. GREGORY WILLIAM COLEY O.D.

Table of content: (NPI 1306615281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295760981 NPI number — DR. GREGORY WILLIAM COLEY O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEY
Provider First Name:
GREGORY
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.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:
1295760981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
129 E CLARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURFREESBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37130-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-893-8847
Provider Business Mailing Address Fax Number:
615-896-3677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 E CLARK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37130-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-893-8847
Provider Business Practice Location Address Fax Number:
615-896-3677
Provider Enumeration Date:
07/11/2006

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: 152W00000X , with the licence number:  1100 , 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: 3598283 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4052027 . This is a "BC/BS GROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 9366060 . This is a "PHCS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2240263 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3052066 . This is a "TN CARE SELECT" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0448280001 . This is a "DMERC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 12642 . This is a "HEALTHNET BLOCK" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3052066 . This is a "BC/BS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7102000TN37130 . This is a "BC/BS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1668918 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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