1346515897 NPI number — TIF W SIRAGUSA

Table of content: DR. DOMENIC FOBBE FRABONI DPT (NPI 1891337671)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346515897 NPI number — TIF W SIRAGUSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIF W SIRAGUSA
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:
6
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:
1346515897
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5651 FRIST BLVD
Provider Second Line Business Mailing Address:
SUITE 414
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37076-2054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-884-7600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5651 FRIST BLVD
Provider Second Line Business Practice Location Address:
SUITE 414
Provider Business Practice Location Address City Name:
HERMITAGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37076-2054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-884-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SIRAGUSA
Authorized Official First Name:
TIF
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-884-7600

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  43966 , 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: 1527328 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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