1750384780 NPI number — DR. JULIE A PERRIGIN MD

Table of content: DR. JULIE A PERRIGIN MD (NPI 1750384780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750384780 NPI number — DR. JULIE A PERRIGIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRIGIN
Provider First Name:
JULIE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1750384780
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 778
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DICKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37056-0778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-446-0522
Provider Business Mailing Address Fax Number:
615-446-4737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37055-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-446-0522
Provider Business Practice Location Address Fax Number:
615-446-4737
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: 207Q00000X , with the licence number:  MD36337 , 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: 4036680 . This is a "BCBS TN PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4149034 . This is a "BCBS TN PIN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 080184264 . This is a "RAILROAD MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4271845 . This is a "BCBS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: Q002040 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4139135 . This is a "BLUE CROSS BLUE SHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".