1316029648 NPI number — INFECTIOUS DISEASE CONSULTANTS OF JACKSON, PC

Table of content: CATHY J. LEE N.P. (NPI 1578848941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316029648 NPI number — INFECTIOUS DISEASE CONSULTANTS OF JACKSON, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFECTIOUS DISEASE CONSULTANTS OF JACKSON, 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:
1316029648
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1804 HIGHWAY 45 BYP
Provider Second Line Business Mailing Address:
SUITE 604
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38305-4436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-660-8759
Provider Business Mailing Address Fax Number:
731-660-8739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 OAKHAVEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38305-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-425-6067
Provider Business Practice Location Address Fax Number:
731-660-8739
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AHERRERA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
731-425-6067

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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