1467472258 NPI number — ST. THOMAS MEDICAL GROUP PLLC

Table of content: (NPI 1467472258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467472258 NPI number — ST. THOMAS MEDICAL GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. THOMAS MEDICAL GROUP PLLC
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:
1467472258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 WOODMONT BLVD
Provider Second Line Business Mailing Address:
SUITE LL50
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37205-2382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-386-2300
Provider Business Mailing Address Fax Number:
615-386-2399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4230 HARDING PIKE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-2013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-297-2700
Provider Business Practice Location Address Fax Number:
615-386-2399
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRAYSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
615-250-4142

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CB3852 . This is a "MEDICARE RR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 613258400 . This is a "OWCP - DOL AUDIOLOGISTS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3721520 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65940066 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4019754 . This is a "BLUE CROSS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 10074025 . This is a "AMERIGROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 166556000 . This is a "OWCP DOL WORK COMP - MEDICAL PROVIDERS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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