1568413219 NPI number — HARRISON G. SIMS III M.D.

Table of content: DANIEL NOLLEN (NPI 1285393926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568413219 NPI number — HARRISON G. SIMS III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMS
Provider First Name:
HARRISON
Provider Middle Name:
G.
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
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:
1568413219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 WESTSIDE DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37312-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-339-1760
Provider Business Mailing Address Fax Number:
423-559-1483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 WESTSIDE DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37312-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-339-1760
Provider Business Practice Location Address Fax Number:
423-559-1483
Provider Enumeration Date:
05/15/2006

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: 207Q00000X , with the licence number:  037149 , 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: 3880829 . This is a "MEDICARE - INDIVIDUAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1584772 . This is a "GHI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3880829 . This is a "MEDICAID - INDIVIDUAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: G62659 . This is a "MEDICARE UPIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3719860 . This is a "MEDICARE - GROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3880829 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: G62659 . This is a "HEALTHSPRING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 392704 . This is a "BCBS GA - INDIVIDUAL" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 4052544 . This is a "BCBS TN - INDIVIDUAL" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0102 . This is a "UHC RIVER VALLEY / JDHC" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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