1538173471 NPI number — COOKEVILLE PEDIATRIC ASSOCIATES, PLLC

Table of content: (NPI 1538173471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538173471 NPI number — COOKEVILLE PEDIATRIC ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOKEVILLE PEDIATRIC ASSOCIATES, 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:
1538173471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 N WILLOW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38501-2368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-528-1485
Provider Business Mailing Address Fax Number:
931-526-4233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 N WILLOW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501-2368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-528-1485
Provider Business Practice Location Address Fax Number:
931-526-4233
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRANKLIN
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
931-265-5836

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  208000000X , 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: 1043279987 . This is a "ROBERT TREECE NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1912962945 . This is a "LLOYD D. FRANKLIN NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1124050687 . This is a "MARY LOGHRY NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1508825902 . This is a "JAMES BATSON NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1512646 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1205060415 . This is a "KELLEY HENSON NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3898235 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922232131 . This is a "LISA HARTMAN NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5440738 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1609835644 . This is a "LESLIE TREECE NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3897667 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1538173471 . This is a "COOKEVILLE PEDIATRICASSOCIATES NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1512648 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3001286 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5440812 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1517710 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1972783793 . This is a "KASSIE BARNES NPI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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