1295922961 NPI number — TERRY M. BINGHAM, MD, PC

Table of content: RUSSELL JENSON PAPPAS LMT, NCTMB (NPI 1588820617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295922961 NPI number — TERRY M. BINGHAM, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERRY M. BINGHAM, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1295922961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1855 TANNER WAY
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
HARRIMAN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37748-8302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-882-2442
Provider Business Mailing Address Fax Number:
865-882-0251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 N GATEWAY AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HARRIMAN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37748-8609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-882-2442
Provider Business Practice Location Address Fax Number:
865-882-0251
Provider Enumeration Date:
09/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BINGHAM
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
865-882-2442

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD0000010262 , 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: 1740063 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0014290 . This is a "BLUE CROSS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 020000758 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0101 . This is a "JOHN DEERE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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