1831144039 NPI number — DEBASHIS BISWAS M.D.

Table of content: DEBASHIS BISWAS M.D. (NPI 1831144039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831144039 NPI number — DEBASHIS BISWAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISWAS
Provider First Name:
DEBASHIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1831144039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6325 HUMPHREYS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38120-2300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-522-7700
Provider Business Mailing Address Fax Number:
662-536-0566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 STATELINE RD E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHAVEN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38671-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-536-0577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2006

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: 2084N0400X , with the licence number:  37773 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: M18215 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 470882104 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 470882104 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: H19481 . This is a "HEALTHSPRINGS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0019896 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4076438 . This is a "BCBS OF TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: Q015836 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7486187 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 388061 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08601532 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 29610 . This is a "TLC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com