1437119864 NPI number — DR. SAMUEL R. ORR M.D.

Table of content: GAYL SUE TIEBEN (NPI 1265052419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437119864 NPI number — DR. SAMUEL R. ORR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORR
Provider First Name:
SAMUEL
Provider Middle Name:
R.
Provider Name Prefix Text:
DR.
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:
1437119864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3901 CENTRAL PIKE
Provider Second Line Business Mailing Address:
SUITE 251
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37076-3419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-232-8033
Provider Business Mailing Address Fax Number:
615-885-7838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 S HARTMANN DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37090-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-466-9770
Provider Business Practice Location Address Fax Number:
615-466-9782
Provider Enumeration Date:
03/28/2006

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: 208000000X , with the licence number:  K9376 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 49814 , 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: 1441099-02 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: Q000548 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1441099-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 370018989 . This is a "RR/MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 49814 . This is a "STATE LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 8B0916 . This is a "BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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