1528433802 NPI number — HOSPITAL MEDICINE SERVICES OF TENNESSEE PC

Table of content: (NPI 1528433802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528433802 NPI number — HOSPITAL MEDICINE SERVICES OF TENNESSEE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITAL MEDICINE SERVICES OF TENNESSEE PC
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:
1528433802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638984
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-8984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-424-3672
Provider Business Mailing Address Fax Number:
954-377-3042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 WILSON CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47025-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-537-1010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DABBS
Authorized Official First Name:
RANDAL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-424-3672

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X ; 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: 363LA2200X ; 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: 7100406750 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q018841 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201370030A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100399990 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".