1457439325 NPI number — PAIGE W TENCH MD

Table of content: PAIGE W TENCH MD (NPI 1457439325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457439325 NPI number — PAIGE W TENCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TENCH
Provider First Name:
PAIGE
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1457439325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4947
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31208-4947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-301-2362
Provider Business Mailing Address Fax Number:
478-301-2272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-301-4111
Provider Business Practice Location Address Fax Number:
478-301-5812
Provider Enumeration Date:
11/01/2006

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: 2084P0800X , with the licence number:  032668 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 042466903A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00322698 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".