1609879741 NPI number — DR. BERNARD C TEKIELE OD

Table of content: DR. BERNARD C TEKIELE OD (NPI 1609879741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609879741 NPI number — DR. BERNARD C TEKIELE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEKIELE
Provider First Name:
BERNARD
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1609879741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 RIVERGATE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOODLETTSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37072-2030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-859-3937
Provider Business Mailing Address Fax Number:
810-733-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2501 21ST AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37212-5626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-406-1571
Provider Business Practice Location Address Fax Number:
615-859-3919
Provider Enumeration Date:
05/23/2005

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: 152W00000X , with the licence number:  4901004224 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z00115 . This is a "VIVA HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51060953TEK . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 2210338 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 000060953 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410041318 . This is a "MEDICARE TRAVELERS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4799000 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4809545 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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