1487621926 NPI number — DR. MARK A BRZEZIENSKI MD

Table of content: DR. MARK A BRZEZIENSKI MD (NPI 1487621926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487621926 NPI number — DR. MARK A BRZEZIENSKI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRZEZIENSKI
Provider First Name:
MARK
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1487621926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
979 E 3RD ST
Provider Second Line Business Mailing Address:
SUITE C920
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37403-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-756-7134
Provider Business Mailing Address Fax Number:
423-763-4571

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
979 E 3RD ST
Provider Second Line Business Practice Location Address:
SUITE C920
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37403-2136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-756-7134
Provider Business Practice Location Address Fax Number:
423-763-4571
Provider Enumeration Date:
03/03/2006

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: 2086S0105X , with the licence number:  26787 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 26787 , 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: 3010836 . This is a "BCBS INSURANCE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0109 . This is a "JOHN DEERE INSURANCE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000666487E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00666487A , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00004138 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2006636 . This is a "BCBS GROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: GA0103 . This is a "JOHN DEERE INSURANCE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1114640001 . This is a "PALMETTO DME" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1300157 . This is a "UHC INSURANCE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1348080 . This is a "UHC INSURANCE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 52577068004 . This is a "BCBS INSURANCE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 04051010007 . This is a "PALMETTO DME" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 240004382 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: PLF03906636 . This is a "CHAMPUS INSURANCE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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